Hi-R-Ed Online

As mentioned in Study 1, the first medication prescribed is often an antibiotic that is effective against the main types of bacteria that cause cellulitis (streptococci and staphylococci). If the infection is limited to a small area, has not spread to the blood stream or lymphatic system, and the person has no other medical problems, oral antibiotics such as penicillin are effective [1]. If the infection is more widespread, a person will be given intravenous antibiotics as the treatment of choice [2].

Howden and Richards examine the efficacy of continuous infusion of flucloxacillin in the home. This has traditionally been an in-hospital regimen due to the need for continuous infusion. With the advent of portable battery-operated infusion pumps and peripherally inserted central catheters (PICC) lines this regimen can now be delivered safely and more cost effectively in the home.

Patients either had serious methicillin-susceptible Staphylococcus aureus (MSSA) (36) or cellulitis (26). Required for this study, and for home care agencies as well, is the fact that all patients were suitable for home IV therapy. Patients were stable (physically and mentally) with social support, no known drug allergy to the prescribed agent, no drug incompatibility, and consented to homecare. All patients received intermittent flucloxacillin in the hospital and were changed to continuous infusion on discharge at the same total daily dosage [3]. Delivery was via a portable pump by means of an intravenous catheter (peripheral for short term delivery and PICC lines for more long-term delivery). The end points for serious MSSA infections were cure, or for patients with prosthetic joint infection, adequate suppression of the infection. The end point for cellulitis patients was resolution of the rash. Adequate suppression of infection in these patients was defined as no clinical or laboratory evidence of active infection [3].

This study included 62 patients split with a slight weighting towards the MSSA group, with 36 patients in the MSSA group and 26 in the celllulitis group.

The authors conclude from these results that continuous flucoxacillin provides an effective alternative form of treatment for serious MSSA and cellulites infections. Thrd generation cephalosporins, as seen in Study 1, are an effective treatment as well ^{4, 5}.

The results indicate that continuous infusion of flucloxacillin was successful in treating the infection in both the MSSA and cellulitis groups. However, this study had a number of limitations. First of all, it was not truly comparative. Some of the MSSA patients were being treated with other oral antibiotic agents, which confused the results of that group. Second, the high success rates with continuous infusion therapy make it unlikely that comparative studies with intermittent dosing or alternative agents will show better outcomes. Benefits are likely to lie with patient convenience, and less quantifiable benefits such as the reduced selective pressure for antimicrobial resistance with the use of narrow-spectrum agents. Third, although flucloxacillin concentrations were consistently high, they were measured in a small number of patients. And fourth, the period of follow-up for patients with prosthetic joint infection and osteomyelitis was relatively short when considering that late relapses can occur; however continuous infusion therapy did achieve adequate control of these infections.

Further studies are indicated to address the optimal dosing and duration of continuous flucloxacillin, however, using the criteria of cure and cost effectiveness, this study was successful in curing the infection at home using the traditional penicillin derivative drug.