266. The Efficacy of Intramuscular Benzathine Penicillin for Preventing Recurrent Cellulitis: A Nationwide Population-Based Study
Session: Poster Abstract Session: Clinical: Skin and Soft Tissue
Thursday, October 5, 2017
Room: Poster Hall CD
  • (2017) ID week 266 The Efficacy of Intramuscular Benzathine Penicillin for Preventing Recurrent Cellulitis A Nationwide Population-Based Study.pdf (1013.4 kB)
  • Background: Recurrent cellulitis is a vexing clinical problem with huge financial burden on healthcare resources. Though intramuscular antibiotics had been suggested as a prevention strategy but the evidence is scarce.

    Methods: We conducted a cohort study by using Taiwan’s National Health Insurance Research Database (NHIRD) between 2000 and 2008. Patients received intramuscular benzathine pencillin 2.4 MU every 4 weeks at least three prescriptions within half a year were enrolled and followed for one year since the first dose. The prevention efficacy was determined by comparing the incidence of recurrent cellulitis in the prophylactic period to non-prophylactic period in each enrolled subject by a Poisson regression model. The prophylactic period was defined as 4 weeks after the date of each dose of benzathine penicillin injection and non-prophylactic period was the time not covered by penicillin during the follow-up period.

    Results: A total of 211 patients were enrolled, including 123(58.3%) men. An average of 7.9 doses of IM benzathine penicillin were given in the study period. The incidence rate of recurrent cellulitis in the prophylactic period was 0.31 episode/patient-year, significantly lower than that of 0.77 episodes/patient-year in the non-prophylactic period (p = 0.004). The common underlying diseases of enrolled patients included diabetes mellitus (73, 35.4%), tinea pedis (69, 33.5%), impaired venous drainage (20, 9.7%), joint replacement of lower extremity (13, 6.3%) and edema status including congestive heart failure (19, 9.2%), chronic renal failure (15, 7.3%), and cirrhosis (8, 3.9%). In multivariate analysis of Poisson regression model, penicillin prophylaxis was associated with lower recurrence (relative risk (RR), 0.30; 95% confidence interval (CI), 0.13-0.69, p=0.005), in contrast, impaired venous drainage (RR 2.78; CI, 1.20-6.48, p=0.018) and tinea pedis (RR 3.04; CI, 1.17-7.90, p=0.022) were associated with higher risk of recurrence.


    The study was the largest cohort that demonstrated intramuscular injection of 2.4 million units benzathine penicillin with 4-week interval significantly reduced the incidence of recurrent cellulitis.

    Szu-Han Lin, M.D.1, Yu-Lin Lee, M.D.1,2, Yen-Yu Chen, M.D.3,4, Yi-Chun Yeh, MPH4 and Chun-Eng Liu, M.D.1,5, (1)Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, (2)Center for Infection Prevention and Control, Changhua Christian Hospital, Changhua, Taiwan, (3)Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan, (4)Research Education and Epidemiology Center, Changhua Christian Hospital, Changhua, Taiwan, (5)Infection control and prevention Unit, Changhua Christian Hospital, Changhua, Taiwan


    S. H. Lin, None

    Y. L. Lee, None

    Y. Y. Chen, None

    Y. C. Yeh, None

    C. E. Liu, None

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