Rationale:

• Many oral antimicrobials exhibit complete oral bioavailability. Absent nausea or diarrhea, there may be no advantage in administering parenteral antimicrobials.
• Switching from parenteral to oral antimicrobials may be impeded by patient or physician bias that the parenteral form is somehow more potent or effective.
• Antimicrobial therapy when prolonged may result in higher cost, greater likelihood of adverse reactions, and may encourage antimicrobial resistance.

Evidence:

• Comparative trials have shown equivalence between parenteral and orally administered antimicrobials in the treatment of complex soft tissue infections (121; 153).
• Trials comparing 5 days to 10 days of treatment of cellulitis have reported no difference in efficacy (154).
• Early discharge from the hospital of patients with cellulitis when compared to conventional discharge results in similar outcomes except that the former may be associated with more rapid convalescence (61; 62).
• Steroids shorten the time to healing by 1 day (82; 83). The use of corticosteroids in patients with severe, exudative pharyngitis, caused predominantly by group A streptococci, results in more rapid resolution of symptoms and signs of inflammation (155).
• NSAIDs shorten the time to healing by 1 to 2 days (84).

Comments:

• Patients with cellulitis and soft tissue infection are often treated for 10 to 14 days or until signs of inflammation resolve. This practice assumes that inflammation is due to continued survival of organisms within the inflamed area. After several days of antimicrobials, inflammation sustained by antigens released from dead bacteria may be merely a residuum of the infection.