Management and prevention of lower leg cellulitis: a survey assessing practice variation and equipoise among Australasian clinicians in preparation for a randomised clinical trial.

BACKGROUND

Lower limb cellulitis accounts for 1.5%-2% of visits to Australasian emergency departments. Antibiotics are considered the cornerstone of management, but despite prioritisation by consumers, acute interventions to manage pain and inflammation and cellulitis recurrence prevention strategies remain understudied beyond small pilot trials.

AIMS: We aimed to assess clinicians' current practices, areas of clinical uncertainty and willingness to randomise patients to interventions, including demarcation lines, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, compression therapy, exercise, antibiotic prophylaxis and a hypothetical streptococcal vaccine for cellulitis prevention.

METHODS

A cross-sectional online survey, consisting of 22 questions assessing clinical practices and equipoise for randomisation into a future trial, was distributed to practicing Australasian clinicians specialising in infectious diseases, lymphoedema physiotherapy, internal medicine, emergency medicine or surgery.

RESULTS

A total of 250 (response rate of ~10%) respondents completed the survey from 77 unique institutions. Lower limb cellulitis was common, with 91 respondents reporting >200 presentations at their institution annually. For most assessment, management and prevention strategies, there was wide variation in clinical practice. Overall, respondents were comfortable considering randomising to possible interventions including drawing (or removing) a line around cellulitis (91.3%), NSAIDs (90.2%) or corticosteroids (74.2%), acute compression (90.7%), exercise (96.4%) and prevention strategies such as injectable benzathine penicillin G (BPG; 87.2%) or a hypothetical streptococcal vaccine (92.7%). Most (62%) respondents expressed interest in a clinical trial of lower limb cellulitis.

CONCLUSION

Novel interventions for acute management and secondary prevention of cellulitis have clinical equipoise. A large, multicentre cellulitis trial is likely to be feasible in Australasian hospitals.