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MAJ Matthew J. Hepburn, MC, USA; COL David P. Dooley, MC, USA; MAJ Peter J. Skidmore, MC, USA; MAJ Michael W. Ellis, MC, USA; MAJ William F. Starnes, MSC, USA; LTC William C. Hasewinkle, MC, USA

Arch Intern Med. 2004;164:1669-1674.

Background  Cellulitis is a condition routinely encountered in the primary care setting. No previous study has compared a short (5 days) vs standard (10 days) course of therapy of the same antibiotic in patients with uncomplicated cellulitis.

Methods  We performed a randomized, double-blind, placebo-controlled trial to determine if 5 days of therapy has equal efficacy to 10 days of therapy for patients with cellulitis. Of 121 enrolled subjects evaluated after 5 days of therapy for cellulitis, 43 were randomized to receive 5 more days of levofloxacin therapy (10 days total antibiotic treatment), and 44 subjects to receive 5 more days of placebo therapy (5 days of total antibiotic treatment). Levofloxacin was given at a dose of 500 mg/d. Subjects were not randomized if they had worsening cellulitis, a persistent nidus of infection, a lack of any clinical improvement, or abscess formation within the first 5 days of therapy. The main outcome measure was resolution of cellulitis at 14 days, with absence of relapse by 28 days, after study enrollment.

Results  Eighty-seven subjects were randomized and analyzed by intention to treat. There was no significant difference in clinical outcome between the 2 courses of therapy (success in 42 [98%] of 43 subjects receiving 10 days of antibiotic, and 43 [98%] of 44 subjects receiving 5 days of antibiotic) at both 14 and 28 days of therapy.

Conclusion  In patients with uncomplicated cellulitis, 5 days of therapy with levofloxacin appears to be as effective as 10 days of therapy.

From the Departments of Medicine (Drs Hepburn, Dooley, Skidmore, and Ellis) and Pharmacy (Drs Starnes and Hasewinkle), Brooke Army Medical Center, Fort Sam Houston, Tex. Dr Hepburn is now with the US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Md; Dr Skidmore is now with the Department of Medicine, Dwight David Eisenhower Army Medical Center, Fort Gordon, Ga; and Dr Starnes is now with the Pharmacy Service, USAMEDDAC, Würzburg, Germany. The authors have no relevant financial interest in this article.

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