In the past, I typically haven't done a whole lot of single study reviews, but this one

excited me today.

It's from the August 13th, 2020 New England Journal Medicine, and it has to deal with

cellulitis, which we see frequently as an acute inflammatory condition of the dermis and

subcutaneous tissue.

And typically in the hospital where we see this, while we can see it of the face and many other areas, really any area of the skin on the body,

we often see it in the lower extremities. And so you get this localized pain and your etymia

and swelling and heat involving that area. And what we notice with

these patients is it often reoccur. So subjectively, we'll see on their past medical history

or we'll talk with them and they'll be like, yeah, I've had it in the past. And that's actually

not subjective, meaning that 47% of patients have a recurrence within three

years. It is a very recurrent condition. And so obviously if something has a very high likelihood

of reoccurring, we want to try and prevent that. Unfortunately, we've had very few trials that have shown efficacy in doing that.

If you do a Cochrane review, it does say that antibiotic prophylaxis is the only treatment

that has been supported by randomized trials. And so, for example, in 2013 in the New England Journal of Medicine,

there was a trial that showed penicillin prophylaxis is effective in preventing recurrence of

cellulitis. But we've never really had a non-drug therapy that's been proven to work.

In the problem with penicillin prophylaxis other than the typical problems you can

run into with antibiotics, including resistance and other issues, is that once you stop the

prophylaxis, that protective effect of the penicillin does go away. Obviously, there's other bigger

issues that as we get into more and more

resistant organisms that penicillin does not have much efficacy for, when you have all these

...