Do We Need Cephalexin Plus TMP-SMX?

Do we really need to cover MRSA?
Clay Smith
For uncomplicated cellulitis, cephalexin alone was just as good as combined TMP-SMX plus cephalexin in the per-protocol analysis.  "Per-protocol" patients took most of the medication and followed up in person.  There was also no statistical difference in the intention-to-treat analysis, though the upper confidence interval exceeded 10%.  Be aware of the study's exclusion criteria.  It only evaluated uncomplicated cellulitis, confirmed to have no abscess on bedside ultrasound. Therefore, patients with abscess/furuncle, IVDA, immunocompromise, (and more...) were excluded.  The study concluded enrollment 5 years ago; organisms and resistance patterns may have changed or may be different in your hospital.  The IDSA recommended monotherapy with cephalexin for non-purulent cellulitis years ago.

Spoon Feed
For uncomplicated cellulitis in otherwise healthy patients, cephalexin alone is probably adequate.  Read more on EM Lit of Note.

Source
Effect of Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis: A Randomized Clinical Trial.  JAMA. 2017 May 23;317(20):2088-2096. doi: 10.1001/jama.2017.5653.

Peer Reviewed by Thomas Davis.

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