Adjunctive clindamycin for cellulitis: a clinical trial comparing flucloxacillin with or without clindamycin for the treatment of limb cellulitis.
To compare flucloxacillin with clindamycin to flucloxacillin alone for the treatment of limb cellulitis.



Parallel, double-blinded, randomised controlled trial.



Emergency department attendances and general practice referrals within 20 hospitals in England.



Flucloxacillin, at a minimum of 500 mg 4 times per day for 5 days, with clindamycin 300 mg 4 times per day for 2 days given orally versus flucloxacillin given alone.



The primary outcome was improvement at day 5. This was defined as being afebrile with either a reduction in affected skin surface temperature or a reduction in the circumference of the affected area. Secondary outcomes included resolution of systemic features, resolution of inflammatory markers, recovery of renal function, reduction in the affected area, decrease in pain, return to work or normal activities and the absence of increased side effects.



410 patients were included in the trial. No significant difference was seen in improvement at day 5 for flucloxacillin with clindamycin (136/156, 87%) versus flucloxacillin alone (140/172, 81%)-OR 1.55 (95% CI 0.81 to 3.01), p=0.174. There was a significant difference in the number of patients with diarrhoea at day 5 in the flucloxacillin with clindamycin allocation (34/160, 22%) versus flucloxacillin alone (16/176, 9%)-OR 2.7 (95% CI 1.41 to 5.07), p=0.002. There was no clinically significant difference in any secondary outcome measures. There was no significant difference in the number of patients stating that they had returned to normal activities at the day 30 interview in the flucloxacillin with clindamycin allocation (99/121, 82%) versus flucloxacillin alone (104/129, 81%)-adjusted OR 0.90 (95% CI 0.44 to 1.84).



The addition of a short course of clindamycin to flucloxacillin early on in limb cellulitis does not improve outcome. The addition of clindamycin doubles the likelihood of diarrhoea within the first few days.



NCT01876628, Results.
Microbiology and Infectious Diseases, Bristol Royal Infirmary, Bristol, UK.
Richard
R
Brindle
Microbiology and Infectious Diseases, Bristol Royal Infirmary, Bristol, UK.
O Martin
OM
Williams
General Practice Support Unit, Bristol Royal Infirmary, Bristol, UK.
Paul
P
Davies
Department of Emergency Medicine, Royal London Hospital, London, UK.
Tim
T
Harris
Department of Emergency Medicine, St George's University Hospitals, London, UK.
Heather
H
Jarman
Centre for Academic Primary Care, University of Bristol, Bristol, UK.
Alastair D
AD
Hay
Acute Medicine Unit, Queen Alexandra Hospital, Portsmouth, UK.
Peter
P
Featherstone
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002481:Cellulitis / Q000188:drug therapy*; D002981:Clindamycin / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005121:Extremities / Q000473:pathology*; D005260:Female; D005436:Floxacillin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged
D000900:Anti-Bacterial Agents; D002981:Clindamycin; D005436:Floxacillin
cellulitis; clindamycin; diarrhoea; erysipelas; flucloxacillin; limb