Cellulitis
About this PSP
Cellulitis is an under-researched topic area yet it accounts for 2-3% of hospital admissions. The number of people affected by cellulitis and its associated complications demonstrates the need for further research into the diagnosis, treatment and prevention of this condition. It is important that patients, carers and health professionals all have a say in future research.
Launched in March 2016, this PSP was funded by the UK Dermatology Clinical Trials Network and co-ordinated by the Centre of Evidence Based Dermatology.
An important aspect of the work of a PSP is identifying the relevant systematic reviews to extract and confirm research uncertainties for the prioritisation process. This requires comprehensive searches of the literature to be carried out. The Cellulitis PSP, co-ordinated by the Centre of Evidence Based Dermatology took the opportunity to create a public online database of cellulitis systematic reviews, mapped by topic.
This database represents a very useful long-term outcome of the work done for the PSP.
The Cellulitis Top 10 was published in May 2017.
Impact of Top 10s
Top 10 priorities
- How can healthcare professionals be best supported to accurately diagnose and manage cellulitis and to advise their patients in how to prevent relapses? (This uncertainty includes the development of tests or tools to assist with the diagnosis and management of cellulitis.)
- What are the best diagnostic criteria for cellulitis, and are they different for different patient groups (e.g. people with lymphoedema)?
- When treating cellulitis, could a higher initial dose and / or longer course of antibiotics result in a quicker recovery and / or fewer relapses?
- What is the best NON-antibiotic intervention for the prevention of cellulitis (e.g.skin care, foot care, moisturisers, antiseptics, lifestyle changes such as weight loss and exercise, compression garments/bandages, treating athlete’s foot, complementary and alternative therapy)?
- Does rest / elevation during an episode of cellulitis help to speed up recovery and improve symptoms, compared to exercise/movement of the affected limb?
- Is the duration, dose and method of administration of antibiotics needed to treat cellulitis related to patient characteristics (e.g. patients with diabetes, who are overweight or have swelling of the limb may require a higher dose/duration)?
- What are the early signs and symptoms of cellulitis that can help to ensure speedy treatment?
- What type of patients are most likely to benefit from low-dose antibiotics to prevent repeated episodes of cellulitis?
- Is there a role for the use of compression garments / bandages on the affected limb during an episode (when tolerable), or immediately following an episode of cellulitis, to speed recovery and reduce complications and recurrence?
- How safe are long-term antibiotics for the prevention of recurrent cellulitis?
The following questions were also discussed and put in order of priority at the workshop:
- What is the best and safest antibiotic, or combination of antibiotics, to treat cellulitis?
- When treating an episode of cellulitis, what features should prompt a change in antibiotic treatment and after what duration?
- Which patients are most likely to benefit from intravenous (IV) antibiotics (as inpatient or outpatient) for the treatment of cellulitis?
- Can testing (e.g. blood tests or scans) help to give a quicker or more accurate diagnosis of cellulitis?
- What is the best way to ensure speedy treatment of recurrent cellulitis (e.g. keeping antibiotics at home)?
- What are the most appropriate antibiotics for the prevention of cellulitis (including those allergic to penicillin)?
- What is the best treatment to use first when treating cellulitis?
- How long should low-dose antibiotics be taken for to prevent repeat episodes of cellulitis?
- *Is there a role for testing to check that the infection has completely cleared before stopping treatment for cellulitis?
- *Is there a role for tests to identify the type of bacteria causing the cellulitis in deciding the best treatment option?
*Considered important areas to watch for future developments.