Once-daily intravenous cefazolin plus oral probenecid is equivalent to once-daily intravenous ceftriaxone plus oral placebo for the treatment of moderate-to-severe cellulitis in adults

A once-daily regimen of cefazolin (2 g intravenously [iv]) plus probenecid (1 g by mouth) was compared with a once-daily regimen of ceftriaxone (1 g iv) plus oral placebo in a randomized, double-blind equivalence trial of home-based therapy for moderate-to-severe cellulitis in adults. For the assessable recipients of cefazolin-probenecid (n = 59) and ceftriaxone-placebo (n = 57), clinical cure occurred at the end of treatment in 86% and 96% (P = .11), respectively, and was maintained at 1 month of follow-up in 96% and 91% respectively. The mean number of treatment doses ( standard deviation) given was similar in the 2 treatment arms (6.97 +/- 2.6 for cefazolin-probenecid and 6.12 +/- 2,1 for ceftriaxone-placebo; P = .06). The median antibiotic trough concentrations were 2.35 mug/mL for cefazolin and 15.45 mug/mL for ceftriaxone. Patients in the 2 treatment arms were similar with regard to overall rates of adverse reaction (P = .15), but nausea was more common among those in the cefazolin-probenecid arm (P = .048). The once-daily regimen of cefazolin-probenecid is a cheap, practical, and effective treatment option for moderate-to-severe cellulitis, and it avoids the need to use third-generation cephalosporins in most patients.