Failure of Antibiotics for Cellulitis

Diagnosis of cellulitis is based on clinical pattern recognition rather than objective tests, and although classically thought to be caused by gram positive bacteria, the majority of cases are culture negative. Noting the high treatment failure rates in some studies that used potent antibiotics, these authors conducted a systematic review and meta-analysis to determine antibiotic treatment failure rates.

They identified 20 randomized studies, including nearly 4000 patients, that compared antibiotic treatments for cellulitis. All antibiotics evaluated in these studies are known to be effective against streptococci. In 9 trials that used intention to treat analysis, overall treatment failure was 18%. Failure rates varied widely between these s…