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Prophylactic penicillin cuts risk of recurrent cellulitis

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2893 (Published 08 May 2013) Cite this as: BMJ 2013;346:f2893

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Prophylactic penicillin almost halved the incidence of recurrent cellulitis in a recent placebo controlled trial (22% (30/136) v 37% (51/138); hazard ratio 0.55, 95% CI 0.35 to 0.86). A dose of 250 mg twice a day delayed the first episode after randomisation by 94 days overall but worked best during active treatment, which lasted one year. Protection waned once treatment stopped, and recurrence occurred during the next two years in just over a quarter of each group. Patients may need longer treatment to sustain protection, say the authors. We don’t yet know how long.

The 274 participants were mostly British, aged 50-60 years, with a median body mass index of 33. They had a history of recurrent cellulitis, including an index recurrence no more than six months before recruitment. Participants with a body mass index over 33, lymphoedema, or at least three previous episodes had a significantly higher risk of treatment failure. They are the patients most likely to be prescribed long term prophylaxis, and they might need a higher dose, coupled with measures to reduce leg oedema.

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Cite this as: BMJ 2013;346:f2893