alexa Intramuscular Ceftriaxone with Oral Antibiotic Therapy in the Treatment of Outpatient Cellulitis
ISSN: 2332-0877

Journal of Infectious Diseases & Therapy
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Research Article

Intramuscular Ceftriaxone with Oral Antibiotic Therapy in the Treatment of Outpatient Cellulitis

Meghan Theofiles1*, Jasmine R Marcelin2, Lori Herges3, Alberto Marcelin1,4, Julie Maxson1 and Kurt B Angstman1

1Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA

2Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA

3Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA

4Department of Family Medicine, Mayo Clinic Health System, Austin, Minnesota, USA

*Corresponding Author:
Meghan Theofiles
Department of Family Medicine
Mayo Clinic, 200 First St SW, Rochester
MN 55905, Minnesota, USA
Tel: 507-538-8500
E-mail: [email protected]

Received date: May 27, 2016; Accepted date: June 15, 2016; Published date: June 17, 2016

Citation: Theofiles M, Marcelin JR, Herges L, Marcelin A, Maxson J, et al. (2016) Intramuscular Ceftriaxone with Oral Antibiotic Therapy in the Treatment of Outpatient Cellulitis. J Infect Dis Ther 4:284. doi:10.4172/2332-0877.1000284

Copyright: © Theofiles M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Purpose: Oral antibiotics are the treatment of choice for outpatient cellulitis; however, intramuscular (IM) antibiotics are frequently used in addition to oral antibiotics in the clinic setting. This study compared outcomes among patients with cellulitis who were administered IM ceftriaxone in addition to oral antibiotics versus those who received oral antibiotics alone.

Methods: This study was a retrospective chart review of 982 adult primary care patients designed to evaluate rates of treatment failure of outpatient cellulitis among patients who received IM ceftriaxone and oral antibiotics versus oral antibiotics alone. Treatment failure was defined as: 1) hospital admission for intravenous (IV) antibiotics within 30 days of diagnosis, 2) prolonged antibiotic course, or 3) requiring a different antibiotic after initial antibiotic course.

Results: Of the 982 patients in the study cohort, 104 (10.6%) received IM ceftriaxone in addition to oral antibiotics while 878 (89.4%) did not. In the IM ceftriaxone group, hospitalization within 30 days was seen in 10.6% vs. 4.2% of the oral treatment only group (p=0.004). Initial outpatient use of IM ceftriaxone was associated with a 3.031 (95% CI 1.928-4.765, p<0.001) increased adjusted odds ratio for treatment failure. Age, gender, race, the use of tobacco, and diagnosis of diabetes mellitus were not associated with adverse outcomes when controlling for all other variables.

Conclusions: The patients who received an initial dose of IM ceftriaxone in addition to oral antibiotics were more likely to experience treatment failure than the non-ceftriaxone cohort. With increasing emergence of antibiotic resistant organisms, antibiotic prescribing practices must be reviewed to ensure efficacy and minimize risks associated with unnecessary antibiotic exposure.


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