The management of cellulitis and erysipelas at an academic emergency department: current practice versus the literature

Cellulitis and erysipelas are common presentations to emergency departments and family physicians. Evidence-based guidelines for appropriate management of these infections exist in Canada, but inconsistent practices persist. Our objective was to determine the level of adherence to current evidence and guidelines by emergency physicians at the two hospitals in Kingston, Ontario, Canada. We identified all of the electronic medical records of patients who were seen at Kingston General Hospital or Hotel Dieu Hospital between January 1, 2015 and June 30, 2015 and given a diagnosis of cellulitis or erysipelas. We randomly selected 182 charts and conducted a retrospective chart review, manually collecting data for patient demographics, medical history, and medical management. Oral cephalexin alone was given to 44% of our sample, and it was the most common form of therapy for uncomplicated cellulitis. 36% of patients given any antibiotics at all received at least one dose of parenteral antibiotics, despite only 6.7% of these patients showing systemic signs of illness. 88% of those receiving parenteral antibiotics received ceftriaxone, a broad-spectrum, third generation cephalosporin. We found wide variation in antibiotic selection and route of administration for patients presenting to the emergency department with cellulitis or erysipelas. Overuse of antibiotics is common, and we believe the use of parenteral antibiotics may have been unnecessary for some patients in our sample. Emergency physicians should align their management plans more closely with the current guidelines to improve practice and reduce unnecessary administration of broad-spectrum parenteral antibiotics.