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Comment & Response
November 15, 2016

Therapy for Cellulitis

Author Affiliations
  • 1Henry Ford Allegiance Health, Jackson, Michigan
JAMA. 2016;316(19):2045-2046. doi:10.1001/jama.2016.15604

To the Editor In their comprehensive review of cellulitis, Drs Raff and Kroshinsky discussed the limited role of culture in making the diagnosis.1 Although a majority of cases of severe nonsuppurative cellulitis (even those presenting with sepsis) are due to β-hemolytic streptococcus,2 antibiotic therapy in the inpatient setting often is unnecessarily broad, covering methicillin-resistant Staphylococcus aureus (MRSA) and various gram-negative bacteria. The lack of culture data can lead to continued extended broad-spectrum antimicrobial use in these patients. The use of serological testing for β-hemolytic streptococcus is underused in this setting but can lead to diagnosis of an etiological agent in up to 40% of these patients, and subsequently, to the fairly rapid simplification of treatment regimen to a narrow-spectrum agent such as penicillin G.24 Use of serologic testing thus has implications both for cost of antimicrobials and effective antimicrobial stewardship.

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