Pegasus Health 24hr Surgery, 401 Madras Street, Christchurch, New Zealand.
Department of Emergency Medicine, Gold Coast University Hospital, Southport, QLD, Australia.
CJEM. 2024 Jul;26(7):472-481. doi: 10.1007/s43678-024-00718-z. Epub 2024 May 26.
Existing guideline recommendations suggest considering corticosteroids for adjunct treatment of cellulitis, but this is based on a single trial with low certainty of evidence. The objective was to determine if anti-inflammatory medication (non-steroidal anti-inflammatory drugs [NSAIDs], corticosteroids) as adjunct cellulitis treatment improves clinical response and cure.
Systematic review and meta-analysis including randomized controlled trials of patients with cellulitis treated with antibiotics irrespective of age, gender, severity and setting, and an intervention of anti-inflammatories (NSAIDs or corticosteroids) vs. placebo or no intervention. Medline (PubMed), Embase (via Elsevier), and Cochrane CENTRAL were searched from inception to August 1, 2023. Data extraction was conducted independently in pairs. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2. Data were pooled using a random effects model. Primary outcomes are time to clinical response and cure.
Five studies (n = 331) were included, all were adults. Three trials reported time to clinical response. There was a benefit with use of an oral NSAID as adjunct therapy at day 3 (risk ratio 1.81, 95%CI 1.42-2.31, I = 0%). There was no difference between groups at day 5 (risk ratio 1.19, 95%CI 0.62-2.26), although heterogeneity was high (I = 96%). Clinical cure was reported by three trials, and there was no difference between groups at all timepoints up to 22 days. Statistical heterogeneity was moderate to low. Adverse events (N = 3 trials) were infrequent.
For patients with cellulitis, the best available data suggest that oral nonsteroidal anti-inflammatory drugs (NSAIDs) as adjunct therapy to antibiotics may lead to improved early clinical response, although this is not sustained beyond 4 days. There is insufficient data to comment on the role of corticosteroids for clinical response. These results must be interpreted with caution due to the small number of included studies.
Open Science Framework: https://osf.io/vkxae?view_only=fb4f8ca438a048cb9ca83c5f47fd4d81 .
现有指南建议考虑使用皮质类固醇作为蜂窝织炎的辅助治疗，但这仅基于一项低确定性证据的单一试验。本研究旨在确定抗炎药物（非甾体抗炎药 [NSAIDs]、皮质类固醇）作为蜂窝织炎辅助治疗是否能改善临床反应和治愈率。
系统评价和荟萃分析，纳入了接受抗生素治疗的蜂窝织炎患者的随机对照试验，无论年龄、性别、严重程度和环境如何，以及抗炎药物（非甾体抗炎药或皮质类固醇）与安慰剂或无干预的干预措施。从成立到 2023 年 8 月 1 日，检索了 Medline（PubMed）、Embase（通过 Elsevier）和 Cochrane CENTRAL。数据提取由两人独立进行。使用 Cochrane 偏倚风险工具 2 评估偏倚风险。使用随机效应模型对数据进行汇总。主要结局是临床反应和治愈率的时间。
纳入了 5 项研究（n=331），均为成年人。3 项试验报告了临床反应时间。口服 NSAID 作为辅助治疗在第 3 天（风险比 1.81，95%CI 1.42-2.31，I=0%）时有获益。第 5 天两组之间没有差异（风险比 1.19，95%CI 0.62-2.26），尽管异质性很高（I=96%）。3 项试验报告了临床治愈率，在 22 天内所有时间点两组之间均无差异。统计学异质性为中等到低。不良反应（n=3 项试验）不常见。
对于蜂窝织炎患者，现有最佳数据表明，抗生素辅助使用口服非甾体抗炎药（NSAIDs）可能会改善早期临床反应，尽管在第 4 天之后这种效果不会持续。对于皮质类固醇在临床反应中的作用，目前尚无足够的数据进行评论。由于纳入研究数量较少，因此必须谨慎解释这些结果。
开放科学框架：https://osf.io/vkxae?view_only=fb4f8ca438a048cb9ca83c5f47fd4d81 。
