Conclusion:

It can be argued that all studies in the journal club were biased in favor of an IV administration route for antibiotics used in the treatment of cellulitis. This is not the case, it is merely the findings of the researchers behind these trials. Oral antibiotics are discussed by all authors, with Grayson et al., even saying that the patients with mild-to-moderate cellulitis were excluded from the study because they could be better treated with orals than IV antibiotics.

Intravenous infusion of antibiotics has become commonplace in the home market due to better medical devices, (infusion pumps, "needleless" systems and indwelling catheters), better patient and caregiver training, and wider acceptance of this practice. As such, the economies and advantages seen in this type of therapy are now taken somewhat for granted. It is, therefore, important to note that this journal club is supporting a therapy already in common practice.

All of the studies in this journal club were well presented and the research was clean. Trials in Grayson et al., were randomized, blind and prospective. Howden's study was a little less clear, but his intent was not to compare IV antibiotics to another administration route, but rather, to look at continuous infusion flucloxacillin's effectiveness at treating MSSA and cellulitis in side-by-side trials. Study #3 (review) is included merely as support behind the suppositions behind studies 1 and 2. Namely, that while a growing range of infections can be safely and effectively treated at home with IV antibiotics, when treated in the home setting they must be thoroughly assessed for suitability, including clinical stability and social circumstances, and both patient and caregiver consent must be obtained.

Additionally, the Howden Grayson review provides that new dosing regimens and new drugs are enabling an ever widening array of infections to be treated in the home that otherwise would have required hospitalization. All authors noted, though, that the appropriate use of homecare leads to "improved patient and caregiver satisfaction, efficient in-hospital bed use and possibly some financial efficiencies".