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Title: Once or Twice-Daily, Algorithm-Based Intravenous Cephazolin for Home-Based Cellulitis Treatment
Authors: Garrett, Tim ;Harbort, Yvonne ;Trebble, Mary ;Docherty, Toni 
Affliation: Central Coast Local Health District
Issue Date: Aug-2012
Source: Volume 24, Issue 4, pp. 383-392
Journal title: Emergency Medicine Australasia
Abstract: Objective: Cellulitis is a common presentation to the ED and a significant cause of hospitalization that can be managed in hospital-in-the-home programmes. Current clinical-practice guidelines recommend once or twice-daily i.v. antibiotics; however, there is an absence of data describing the impact of these guidelines in real-world practice-based settings. This study aims to describe the safety and effectiveness of home-based cellulitis treatment according to an online treatment algorithm. Methods: Over 12 months, 301 patients with a diagnosis of uncomplicated cellulitis requiring i.v. antibiotics and eligible for home-based therapy completed once-daily (cephazolin plus probenecid) or twice-daily (cephazolin alone) treatment, according to the treatment algo- rithm. Time (days) until non-progression of cellulitis was the primary outcome measure. Length of stay and treatment-related side-effects were also recorded. Results: The mean time until non-progression was 2.11 (95% confidence interval [CI] 1.98–2.23) days versus 2.13 (95% CI 1.81–2.45) days for the once-daily (n = 213) and twice-daily (n = 88) regimens, respectively (P = 0.92, difference in means 0.02 [95% CI -0.36–0.33]). The corresponding mean length of stay was 6.55 (95% CI 5.96–7.15) days versus 7.67 (95% CI 6.69–8.65) days (P = 0.06, difference in means 1.12 [CI 0.03–1.23]). Treatment-related side-effects were reported in 15.5% (33/213 [95% CI 10.6–20.3]) of patients receiving the once-daily regimen compared with 9.1% (8/88 [95% CI 3.1–15.1]) treated twice-daily. Application of the once-daily strategy increased hospital-in-the-home cellulitis-related treatment capacity by 52% (1396/2688 [95% CI 50–54]). Conclusions: An online decision support algorithm can support the effective use of a once or twice-daily treatment regimen for uncomplicated cellulitis. This approach can increase the efficiency and capacity of home-based therapy, resulting in better alignment of treatment options with clinicians and patients’ preferences.
DOI: 10.1111/j.1742-6723.2012.01553.x
ISSN: 1441-0737
Publicaton type: Journal Article
Keywords: Drug Therapy
Community Health Nursing
Appears in Collections:Nursing

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