Duration of ANtibiotic therapy for CEllulitis (DANCE)

Cellulitis is among the most common infections leading to hospitalization, yet the optimal duration of therapy remains ill defined. Pragmatically, Dutch guidelines advise 10-14 days of antibiotics, which is the current standard of care. Recently it has been shown that antibiotic treatment for pneumonia and urinary tract infections can safely and significantly be shortened. Importantly, in an outpatient setting, treatment of uncomplicated cellulitis with 5 days of antibiotics was as effective as 10 days. We hypothesize that there is no difference in outcomes when patients hospitalized with cellulitis are treated with either a short-course (6 days) or standard-course (12 days) of antibiotics.

There is no difference in outcomes when patients hospitalized with cellulitis are treated with either a short-course (6 days) or standard-course (12 days) of antibiotics.

Visits scheduled for day 1, day 2-3, day 5-6, day 14, day 28, and day 90.

Patients are included on day 1 of their hospital cellulitis episode, and judged on eligiblity for randomization on day 5-6. To qualify for randomization, patients must respond to therapy, defined as absence of fever (temp > 38.0°C) and improvement in cellulitis severity score (see below).

Arm 1: Short course (6 days antibiotics, 6 days placebo), experimental
Flucloxacillin (1000mg iv OR, later, 500mg capsules), every 6 hours, for 6 days, followed by: Placebo (for flucloxacillin 500mg) 500mg capsules, every 6 hours, for 6 days

Arm 2: Standard course (12 days antibiotics), active comparator
Flucloxacillin (1000mg iv OR, later, 500mg capsules), every 6 hours, for 6 days, followed by: Flucloxacillin 500mg capsules, every 6 hours, for 6 days