Antibiotic Treatment of Common Infections

More Evidence to Support Shorter Durations

Benjamin J. Smith; George Heriot; Kirsty Buising


Curr Opin Infect Dis. 2020;33(6):433-440. 

In This Article

Skin and Soft Tissue Infection

Several current guidelines recommend treatment durations for cellulitis of 5–10 days for outpatients (or individuals with mild illness) and 7–14 days for inpatients (or individuals with significant systemic features).[45,46] These recommendations are based largely on expert opinion, with limited trial evidence.

For patients undergoing treatment for cellulitis with evidence of early clinical improvement, five days of therapy with levofloxacin has been shown to be noninferior to 10.[47] However, fluoroquinolone therapy is unnecessarily broad spectrum for cellulitis and not typically recommended. A recent RCT investigating the use of beta-lactam short-course therapy (six versus 12 days) in severe cellulitis was unable to demonstrate noninferiority with more frequent relapses in the short arm and higher rates of hospital readmission.[48]

For severe necrotising soft tissue infections, antibiotic therapy is an adjunct to definitive surgical management. Treatment is traditionally continued until source control is adequate and there is resolution of systemic signs of infection.[45] There are no randomized trials evaluating the optimal duration.