Clinical trial NCT00552799: RCT to Investigate if Prophylactic Antibiotics Prevent Further Episodes of Cellulitis (Erysipelas) of the Leg
Official title: Randomised Controlled Trial to Investigate Whether Prophylactic Antibiotics Can Prevent Further Episodes of Cellulitis (Erysipelas) of the Leg (PATCH I)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Cellulitis/Erysipelas of the Leg
Keywords: cellulitis
lymphoedema
penicillin
clinical trial
Lead sponsor: University of Nottingham
Sponsor class: OTHER
Collaborators: name: Action Medical Research
name: UK Dermatology Clinical Trials Network
First posted: 2007-11-02
Enrollment: 274
Sex: ALL
Minimum age (years): 16
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: To assess whether a period of prophylactic penicillin after an episode of cellulitis of the leg reduces the risk of repeat episodes. Participants are randomised to receive 12 months of prophylaxis (penicillin VK 250mg b.d. or placebo). The PATCH I study will recruit only patients with recurrent disease.

Detailed description: Cellulitis of the leg is an common, acute, painful and potentially serious infection of the skin and subcutaneous tissue. It currently accounts for 2-3% of UK hospital admissions. The average length of in-patient stay is 9 days (Hospital Episode Statistics, Department of Health (UK), 2002-2003) and 25-50% of treated patients suffer further episodes and other morbidity, such as oedema and ulceration.

Cellulitis of the lower leg is usually due to streptococcal infection that has entered into the body via a relatively subtle portal, such as toeweb fissures. Penicillin is the most useful of the commonly used oral antibiotics against streptococci, although other agents such as flucloxacillin are often used if staphylococcal infection is a clinical possibility.

There are numerous risk factors for cellulitis of the lower leg and recurrent disease is one the biggest problems.

Existing evidence for the use of prophylactic antibiotics to prevent further episodes is very limited. Two small randomised controlled trials (RCTs) hint at possible benefit, but these studies are very small (16 and 40 participants respectively). Despite this, many physicians routinely use prophylactic antibiotics for recurrent cellulitis, although opinions on the value of such practice is firmly divided.

This study will recruit over a 12-24 month period participants who have completed the therapy for the current episode of cellulitis. Participants will be followed up for up to 24 months with telephone calls at 10 days, 3 months, 6 months, 9 months and 12 months and then every 6 months after completing the intervention. A diary will also be provided as an "aid memoir" to phone calls and to note missed tablets and recurrence of cellulitis.

Eligibility criteria: Inclusion Criteria:

* Diagnosis of cellulitis of either leg AND a history of at least one previous episode of cellulitis of either leg within the three

Exclusion Criteria:

Any doubt about the certainty of the diagnosis of either the index episode or the previous episode (if applicable), will be grounds for exclusion. Additionally, patients with any of the following will be excluded:

* Taken antibiotic prophylaxis (defined as more than 3 months usage) for the prevention of cellulitis within 6 months prior to index episode.
* A time lapse of longer than 12 weeks since the start of treatment for the index episode to the date of potential randomisation into the trial.
* Known allergy to penicillin.
* Preceding leg ulceration, surgery or penetrating trauma, as these cases are more likely to be caused by staphylococcal infection. (NB: this does not exclude patients with toeweb maceration/tinea pedis or other minor/blunt wounds).
* Treating physician or principal investigator unwilling to randomise patient. This includes, but is not limited to:

  * The treating physician and/or patient feels that prophylactic antibiotics are not in the patient's best interests and therefore entry to this study would be inappropriate.
  * The treating physician and/or patient feels it would not be ethical or appropriate for the patient to receive placebo and so they are not willing/able to accept randomisation
  * Concomitant medication that would mean that long-term penicillin is inappropriate
  * Diagnostic uncertainty
  * Gastrointestinal disease causing persistent diarrhoea or vomiting severe enough to affect the absorption of the phenoxymethylpenicillin.
  * Allergic diathesis or severe bronchial asthma severe enough to preclude the use of phenoxymethylpenicillin.
  * Confounding concurrent disease (e.g. DVT).
* No access to a telephone.
* Aged less than 16 years.
* Unable to give informed consent.
* Already taking part in a research study.

Primary outcomes:
measure: The primary outcome is time to next episode of cellulitis
timeFrame: variable
Secondary outcomes:
measure: Secondary outcomes include: i) the proportion of participants with repeat episodes of cellulitis; ii) proportion of participants with oedema and/or ulceration; iii) cost-effectiveness; iv) predictors of response (multiple regression model).
timeFrame: variable
Other outcomes:
Locations:
city: Cork
country: Ireland
facility: South Infirmary-Victoria University Hospital
city: Nottingham
country: United Kingdom
facility: Queens Medical Centre
state: Nottinghamshire
city: Aberdeen
country: United Kingdom
facility: Aberdeen Royal Infirmary
city: Amersham
country: United Kingdom
facility: Amersham Hospital
city: Brighton
country: United Kingdom
facility: Brighton General Hospital
city: Bristol
country: United Kingdom
facility: Bristol Royal Infirmary
city: Carlisle
country: United Kingdom
facility: Cumberland Infirmary
city: Derby
country: United Kingdom
facility: Derbyshire Royal Infirmary
city: Durham
country: United Kingdom
facility: University Hospital of North Durham
city: Gloucester
country: United Kingdom
facility: Gloucestershire Royal Infirmary
city: Great Yarmouth
country: United Kingdom
facility: James Paget University Hospital
city: Hull
country: United Kingdom
facility: Princess Royal Hospital
city: Ipswich
country: United Kingdom
facility: Ipswich Hospital
city: King's Lynn
country: United Kingdom
facility: Queen Elizabeth Hospital
city: Leicester
country: United Kingdom
facility: Leicester Royal Infirmary
city: Liverpool
country: United Kingdom
facility: Broadgreen Hospital
city: Londonderry
country: United Kingdom
facility: Altnagelvin Area Hospital
city: Newcastle upon Tyne
country: United Kingdom
facility: Royal Victoria Infirmary
city: Norwich
country: United Kingdom
facility: Norfolk and Norwich University Hospital
city: Reading
country: United Kingdom
facility: Royal Berkshire Hospital
city: Salford
country: United Kingdom
facility: Hope Hospital
city: Sutton in Ashfield
country: United Kingdom
facility: King's Mill Hospital
city: Swansea
country: United Kingdom
facility: Singleton Hospital
city: Watford
country: United Kingdom
facility: Watford General Hospital
city: York
country: United Kingdom
facility: York Hospital
Study officials:
affiliation: University of Nottingham
name: Hywel Williams, Professor
role: STUDY_DIRECTOR
References: