Background and aims Adults with cellulitis are commonly receive IV antibiotics via hospital-in-the-home (HITH). Children are usually admitted to hospital. Royal Children’s Hospital (RCH) HITH and offers once daily IV ceftriaxone for cellulitis. Concerns remain for some physicians about its anti-staphylococcal activity. We aim to compare the clinical features and outcomes of patients with cellulitis admitted to hospital with IV flucloxacillin to those treated via HITH with IV ceftriaxone.
Methods A retrospective chart review of patients with cellulitis treated with IV antibiotics. Exclusions- complicated cellulitis (abscess, orbital cellulitis, post-operative cellulitis, bites and immunosuppression). Demographics, clinical and microbiological features, antibiotic management and outcomes are related to two groups: inpatients treated with IV flucloxacillin and HITH patients treated with IV ceftriaxone.
Results Over 17 months (2012–2014), 745 children presented to ED with cellulitis: 353 (47%) received IV antibiotics; 169 were excluded (complicated cellulitis, comorbidities, misdiagnosis or miscoding), leaving 184. 47 (26%) were admitted to HITH and 137 (74%) were admitted as inpatients. Initial treatment was IV ceftriaxone in 41 (87%) of HITH patients and IV flucloxacillin in 103 (75%) of inpatients.
HITH patients were older, more likely to have failed prior oral antibiotics, less likely to have periorbital rather than limb cellulitis. Inpatients required longer IV treatment. Readmission rates, adverse events and rates of change of treatment were similar.
Conclusion Some children with moderate/severe cellulitis can be treated via HITH with IV ceftriaxone in this non-randomised study however further prospective work is required to define the most appropriate sub-group.