A new challenge for penicillin: preventing recurrent leg infections

Cellulitis is a common, painful and disabling infection that can strike the same patients time and time again. It accounts for around three percent of all hospital admissions. Although cellulitis responds to antibiotics, there's no solid proof that extended courses prevent it recurring. Could a low dose of penicillin be all that's needed?

What's the problem and who does it affect?

Patients face repeat infection

An extraordinary three percent of people admitted to hospital have an infection called cellulitis. They stay in hospital for around ten days. Despite an effective cure, more than 1 in 4 people get cellulitis again.

Cellulitis begins as a red, painful and tender patch of skin, often on patients' legs. The skin becomes hot and swollen. Some people develop a fever and other more serious symptoms. Without treatment, infection can spread to the bloodstream, becoming life threatening within just a few days.

Doctors lack information on preventing cellulitis

Though doctors can treat cellulitis, they have no clear guidance on how to prevent it. As well as recurrences of cellulitis, many people suffer persistent complications, such as swelling of their leg or ulcers.

Doctors lack funding to research cellulitis. They believe this might be because the disorder doesn't have a high enough profile and attempts to prevent cellulitis often involve a course of penicillin, which some see as old-fashioned.

What's more, research is difficult to coordinate - patients are treated in several different hospital departments and few hospitals see enough patients to perform significant clinical trials independently.

What is the project trying to achieve?

Does penicillin stop cellulitis recurring?

Patients from 10 to 15 hospitals throughout the UK will take part in a clinical trial.

Patients leaving hospital after successful treatment for cellulitis of the leg will be split, randomly, into two groups - one group will take a low dose of penicillin for 12 months, the other will take an inactive placebo tablet. Neither patients nor their doctors will know who receives active treatment.

Over the next three years, doctors will record any recurrences of cellulitis and any leg swelling or ulceration. They will follow patients' progress closely, by posting out questionnaires, telephoning patients periodically, and being readily available for emergency consultations. Patients will complete diaries.

The results should show whether penicillin can stop cellulitis from recurring and prevent leg swelling and ulceration.

What are the researchers' credentials?

The UK Dermatology Clinical Trials Network will coordinate the clinical trial from the co-ordinating centre at the University of Nottingham. This extensive network comprises 170 dermatologists and dermatology nurses. They will help to recruit patients quickly to the study and will spread news of the trial's results, so it will make an immediate impact on how patients are treated.

The project leader, Professor Hywel Williams, and his colleague, Dr Kim Thomas, have both managed several clinical trials in recent years. Dr Neil Cox, the clinical lead for this project, has a long-standing interest in cellulitis. Professor Nick Reynolds has extensive experience of conducting randomised clinical trials. And Professor Mortimer is an international authority on lymphoedema - the leg swelling that is both a cause and complication of cellulitis.

Who stands to benefit from this research and how?

Pencillin: a simple solution

Penicillin is a relatively cheap and simple treatment that is tolerated well by most people. If it stops cellulitis from recurring, and prevents the associated leg swelling and ulceration, penicillin would have a major impact on both patients and the NHS.

Preventing suffering

For patients, successfully preventing cellulitis would bring freedom from long-term suffering. Just one bout of cellulitis is bad enough - bringing pain, disability and a long stay in hospital. But at least one quarter of people go on to suffer from cellulitis again. Patients also face a long-term risk of getting persistent swelling or ulcers in their leg. Indeed, the problem can be cyclical, as the swelling can itself cause further episodes of cellulitis.

Saving money

Preventing cellulitis would also save the NHS a significant amount of money. With an average inpatient stay of ten days, each patient costs the NHS an estimated £1500 every time they become ill. Since three percent of hospital admissions are for cellulitis, costs to the NHS soon mount up.