PMID- 37921834 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20231120 IS - 1929-0748 (Print) IS - 1929-0748 (Electronic) IS - 1929-0748 (Linking) VI - 12 DP - 2023 Nov 3 TI - Comparing Oral Versus Intravenous Antibiotics Administration for Cellulitis Infection: Protocol for a Systematic Review and Meta-Analysis. PG - e48342 LID - 10.2196/48342 [doi] LID - e48342 AB - BACKGROUND: Cellulitis is defined as an infection of the skin that is usually characterized by localized but poorly demarcated areas of erythema, swelling, and pain. Erysipelas is a subtype of cellulitis that is characterized by a more superficial infection, often involving the face. Because gram-positive bacteria are the most common infective agent, beta-lactam antibiotics such as cephalosporins are commonly used. However, guidelines and physician preference vary widely as different antibiotic options and routes of administration exist, in addition to the fact that most cases are treated empirically without microbiological lab guidance. This lack of standardization in evidence, guidelines, and physician practice prompted this systematic review and meta-analysis of both randomized trial data and cohort studies to aggregate the currently available evidence for the optimal routes of antibiotic administration in cellulitis treatment. OBJECTIVE: The primary objective of our review is to compare the efficacy of oral versus intravenous antibiotic administration for cellulitis infections, thereby providing clinicians with evidence-based guidelines for treatment. METHODS: We will search MEDLINE, Embase, and CENTRAL through Ovid as well as Web of Science and CINAHL for all available literature comparing different routes of antibiotic administration in the treatment of cellulitis and erysipelas. We will perform title and abstract as well as full-text screening in duplicate according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines and then extract the relevant data using a prepiloted data sheet. The primary outcome for our review is the duration of infection resolution, and secondary outcomes such as incidence of sepsis, mortality, hospital admission, and Clostridium difficile infection. We will assess the risk of bias in our included studies using the RoB 2.0 (revised tool for Risk of Bias in randomized trials) and ROBINS-I (Risk of bias in non-randomized studies for interventions) tools, with a final quality assessment using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework and a sensitivity analysis to examine heterogeneity. RESULTS: We will publish the final results of our systematic review in a peer-reviewed academic journal. This project received no funding or financial assistance. Data analysis is currently underway, and the results are expected to be submitted for publication in late November 2023. CONCLUSIONS: To our knowledge, this will be the most up-to-date review of the best available evidence comparing different routes of antibiotic administration for cellulitis. Because of the vast selection of antibiotic options available and the empirical nature of the treatment, we anticipate heterogeneity within our data but nonetheless hope to provide aggregated evidence on the efficacy of intravenous versus oral administration of antibiotics in cellulitis treatment. We hope the results from this study will better inform physician practices in the future for cellulitis infections. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/48342. CI - (c)Raymond Yin, Jingyi Jiang, Yiyang Wang, Yuhao Jin, Eric Qian, Chenyang Yue, Coco Jiang, Michelle Wang, Kylie Xu, Xiaoyuan Zhou, Winston Hou. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 03.11.2023. FAU - Yin, Raymond AU - Yin R AUID- ORCID: 0009-0009-4037-5994 AD - Faculty of Science, University of Western Ontario, London, ON, Canada. FAU - Jiang, Jingyi AU - Jiang J AUID- ORCID: 0009-0007-5255-774X AD - Faculty of Science, University of Toronto, Toronto, ON, Canada. FAU - Wang, Yiyang AU - Wang Y AUID- ORCID: 0000-0002-1697-8615 AD - College of Life Sciences, University of California, Los Angeles, Los Angeles, CA, United States. FAU - Jin, Yuhao AU - Jin Y AUID- ORCID: 0009-0007-3277-048X AD - Faculty of Science, University of Western Ontario, London, ON, Canada. FAU - Qian, Eric AU - Qian E AUID- ORCID: 0009-0001-9061-860X AD - Emory University, Atlanta, GA, United States. FAU - Yue, Chenyang AU - Yue C AUID- ORCID: 0000-0003-0852-0409 AD - Faculty of Science, York University, Toronto, ON, Canada. FAU - Jiang, Coco AU - Jiang C AUID- ORCID: 0000-0002-1164-1909 AD - Faculty of Science, University of Toronto, Toronto, ON, Canada. FAU - Wang, Michelle AU - Wang M AUID- ORCID: 0009-0000-0893-5191 AD - Faculty of Science, University of Toronto, Toronto, ON, Canada. FAU - Xu, Kylie AU - Xu K AUID- ORCID: 0009-0007-4979-7195 AD - Faculty of Science, Dawson College, Montreal, QC, Canada. FAU - Zhou, Xiaoyuan AU - Zhou X AUID- ORCID: 0009-0002-7939-7292 AD - Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. FAU - Hou, Winston AU - Hou W AUID- ORCID: 0000-0002-1164-1909 AD - Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. LA - eng PT - Journal Article DEP - 20231103 PL - Canada TA - JMIR Res Protoc JT - JMIR research protocols JID - 101599504 PMC - PMC10656654 OTO - NOTNLM OT - antibiotics OT - cellulitis OT - infection OT - intravenous OT - oral COIS- Conflicts of Interest: None declared. EDAT- 2023/11/03 12:45 MHDA- 2023/11/03 12:46 PMCR- 2023/11/03 CRDT- 2023/11/03 11:52 PHST- 2023/04/19 00:00 [received] PHST- 2023/08/27 00:00 [accepted] PHST- 2023/08/25 00:00 [revised] PHST- 2023/11/03 12:46 [medline] PHST- 2023/11/03 12:45 [pubmed] PHST- 2023/11/03 11:52 [entrez] PHST- 2023/11/03 00:00 [pmc-release] AID - v12i1e48342 [pii] AID - 10.2196/48342 [doi] PST - epublish SO - JMIR Res Protoc. 2023 Nov 3;12:e48342. doi: 10.2196/48342.