2025 Southeastern Residency Conference

Title: Evaluation of duration of antibiotic therapy in cellulitis and abscess treatment

Authors: Taylor Luthringer, Rebecca Orr, Ashley Nebbia, Lauren Seymour

Background:  The Infectious Diseases Society of America guidelines recommend a five- to seven-day course of antibiotics for most skin and soft-tissue infections. In most cases of uncomplicated cellulitis, a five-day course of antimicrobial therapy has shown to be as effective as a ten-day course, if clinical improvement has occurred by day five. The purpose of this study was to evaluate the duration of antibiotics prescribed in the treatment of cellulitis at a community health system.

Methods:  This was a retrospective study of adults >18 yrs old admitted to a multi-campus community health system between January 30, 2024 and June 30, 2024 diagnosed with cellulitis and abscess based on International Classification of Diseases, Tenth Revision (ICD-10) codes. Patients with necrotizing fasciitis, pyomyositis, Group A streptococcal gangrene, osteomyelitis, or diabetic foot infection were excluded from the study.  Patient demographics, total antibiotic duration of therapy (inpatient and discharge), hospital length of stay, readmission rates, infectious disease consult rates, and other clinical data were collected via manual chart review.  Data was analyzed using descriptive statistics. 

Results: 
A total of 224 patients were included in the study.  One hundred sixty-two (72.3%) patients received greater than or equal to eight days of antibiotic therapy and 62 (27.7%) patients received less than eight days of antibiotic therapy. The average inpatient antibiotic duration was 65 hours (2.7 days) and the average discharge prescription duration was 176 hours (7.3 hours), with the total antibiotic duration resulting at 240 hours (10 days) on average. The most commonly chosen initial antibiotics were vancomycin, cefepime, and ceftriaxone.  Fifty (29%) patients were readmitted within 30-days of discharge.  The average length of stay was 3 days. 
 
Conclusion:  
The majority of patients included in the study (72.3%) received antibiotics for 8 days or more and, on average, were treated with a 10 day course of antibiotics. Discharge prescriptions were written for an average of 7.3 day duration, indicating that the length of therapy beyond the guideline-recommended duration is largely due to discharge prescriptions. These results indicate there is a substantial opportunity for clinical pharmacist intervention in ensuring the efficient utilization of hospital resources to improve guideline compliance and reduce unnecessary antibiotic exposure.