Comparison of initial antibiotic choice and treatment of cellulitis in the pre- and post-community-acquired methicillin-resistant Staphylococcus aureus eras

Treatment success of cellulitis in the age of community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA). A comparison of initial antibiotic choice and treatment success in the pre- and post-CAMRSA eras. Objective: The objective of this study is to determine antibiotic prescribing patterns and treatment failure rates for cellulitis in the pre- and post-CAMRSA eras. Methods: We performed an electronic chart review of patients seen in our emergency department with cellulitis in 2000 and 2005. Inclusion criteria included age 18 years or more and received a single oral antibiotic for cellulitis. Exclusion criteria were incision and drainage, surgery, or admission on initial visit. Treatment failure was defined as a repeat visit in the subsequent 30 days and a change in antibiotics, admission to the hospital, incision and drainage of abscess, or surgical intervention. Antibiotic-prescribing practices and treatment failure rates were then compared in the pre- and post-CAMRSA eras. Results: There was a significant decrease in β-lactam antibiotics and an increase in CAMRSA-effective antibiotics prescribed in 2005 vs 2000. The difference in treatment failure rates of the β-lactams and CAMRSA antibiotics was statistically insignificant. There has not been an increase in failure rates of the β-lactam antibiotics for simple cellulitis since the emergence of CAMRSA. Conclusion: Our study demonstrates that prescribing practices for simple cellulitis have changed since the emergence of CAMRSA. This may not be appropriate because β-lactam antibiotics perform as well as 'CAMRSA antibiotics' in our study.