JMIR Publications

ABSTRACT

Background:

Cellulitis is defined as infection of the skin that is usually characterized by localized but poorly demarcated areas of erythema, swelling and pain. Beta-lactam antibiotics such as penicillin or different generations of cephalosporins are commonly used, but guidelines and physician preference vary widely as many different antibiotic options exists. This lack of standardization in evidence, guideline, and physician practice prompted this systematic review and meta-analysis of both randomized trial data as well as cohort studies to aggregate the current available evidence for the optimal routes of antibiotic administration in cellulitis treatment.

Objective:

To evaluate the efficacy of oral versus intravenous antibiotic administration for the treatment of cellulitis.

Methods:

We will search MEDLINE, Embase, and CENTRAL via OVID as well as Web of Science and CINAHL for all available literature comparing different routes of antibiotic administration for the treatment of cellulitis. We will perform title and abstract as well as full text screening in duplicate according to the PRIMSA guidelines, and then extract the relevant data using a pre-piloted data sheet. We will include all antibiotic classes, including studies that compared antibiotics across different classes. The primary outcome for our review is duration to infection resolution, with secondary outcomes such as incidence of sepsis, mortality, hospital admission, C.diff infection, etc. We will assess the risk of bias in our included studies using the ROB2.0 and ROBINS-I tools, with final quality assessment using the GRADE framework.

Results:

We will publish the final results of our systematic review in a peer-reviewed academic journal.

Conclusions:

To our knowledge, this is the most up-to-date and inclusive review of the best available evidence comparing the different routes of antibiotic administration for cellulitis. Because of the vast selection of antibiotic options available and the empirical nature of the treatment without culture guidance, we anticipate heterogeneity within our synthesized data but nonetheless hope to provide the aggregated evidence on the efficacy of intravenous versus oral administration of antibiotics in cellulitis treatment.