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Home IV Antibiotic Treatment for Cellulitis

This treatment is clinically effective, cost-effective, and preferred by patients.

Financial pressures have led to a shift from inpatient to outpatient treatment whenever feasible. In a randomized, controlled trial, researchers in New Zealand evaluated outpatient intravenous antibiotic treatment for cellulitis. Two hundred mentally competent adults (age, 16 or older) with cellulitis who presented to a single emergency department were randomized to receive IV antibiotic treatment either at home or in the hospital. Participants were required to have home telephones and caregivers nearby. Exclusion criteria were pregnancy, severe cellulitis, sepsis, IV antibiotic treatment for cellulitis at the same site in the preceding month, elevated white blood cell count (>12x10⁹/L) or left shift, and comorbid conditions; 194 patients met the study criteria (98 in the home-care group and 96 in the hospital-care group).

Before each patient left the ED, researchers administered a single dose of IV cephazolin (2 g) and marked the peripheral margin of the cellulitis. Patients treated at home were visited twice daily by nurses, who administered additional 2-g doses of IV cephazolin and monitored cellulitis status, and once daily by a primary care physician.

Baseline characteristics were similar in the two groups, except that home-care patients were younger than hospital-care patients (48 vs. 55) and less likely to have low incomes (37% vs. 53%). Pain level, level of physical functioning, and mean number of days to no advancement of cellulitis (the primary outcome) were similar in the two groups. Both groups were satisfied with treatment; however, one third of patients who received hospital care would have preferred home care, whereas only 5% of patients treated at home would have preferred inpatient treatment.

Comment: Managed care organizations will love this article! Not only was at-home treatment more cost-effective, but patients preferred it. Unfortunately, a cost comparison of treatment settings was not done, and the data likely are not generalizable to the U.S., where daily home physician and nurse visits would be more difficult to arrange. Options for cellulitis patients in the U.S. include admission to a 24-hour observation unit and ED administration of IV antibiotics that last 24 hours, with follow-up the next day.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine March 16, 2005

Citation(s):

Corwin P et al. Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital. BMJ 2005 Jan 15; 330:129-32.

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