Burn: prophylactic penicillin did not clearly prevent cellulitis.

Clinical bottom line (level 2b-)

  1. Patients with burns who received penicillin prophylaxis were not clearly less likely to develop cellulitis or burns than those who did not.
Durtschi et al: Journal of Trauma 1982; 22 (1): 11-14
Expires November 2004

The study

Double-blinded concealed randomised trial without intention-to-treat
Setting: burn and trauma centre, university hospital, USA

98 patients (aged range 18 to 77 years; mean 34, 86% male) with burns covering 1% to 91% of their body surface area (mean 20%)

Excluded if
  • electrical burns
  • burns > 48 hours
  • allergy to penicillin
  • antibiotics within 30 days prior
  • established infection
  • treated with biologic dressing
  • diabetes mellitus, steroids/immunosuppressants, massive obesity, severe malnutrition, malignancy


    • Control Group: (n = ., 26 analysed): placebo
    Experimental Group: (n = , 25 analysed): penicillin V potassium 250 mg every 6 hours for 5 days or benzylpenicillin 1.2 million units IV every 12 hours for 5 days

    52% followed for 18 days
    Outcome notes:
    • cellulitis : area of warm, spreading cutaneous erythema accompanied by local pain and fever. Early if during prophylactic administration, otherwise late.

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    cellulitis 18 days 7
    (26.9%)    		 11
    (44.0%)    		 -63%
    (-254% to 25%)    		 -17.1%
    (-43.0% to 8.79%)    		 -6
    (NNT = 11 to infinity;
    NNH = 2 to infinity)
    systemic sepsis 18 days 3
    (11.5%)    		 2
    (8.00%)    		 31%
    (-281% to 87%)    		 3.54%
    (-12.7% to 19.8%)    		 28
    (NNT = 5 to infinity;
    NNH = 8 to infinity)

    Comments

    1. Small sample size and poor follow-up make these results less reliable.

    Citation

    1. Durtschi MB, Orgain C, Counts GW, et al: A prospective study of prophylactic penicillin in acutely burned hospitalized patients. Journal of Trauma 1982; 22 (1): 11-14
    Search Terms: cellulitis therapy
    Contributor: John Epling and Chris Ball, November 2000
    Reviewer:

    Clinical Question.
    Patient burns
    Intervention or Exposure penicillin
    Comparison placebo
    Outcome cellulitis