Ceftriaxone versus cefazolin with probenecid for severe skin and soft tissue infections

To evaluate the hypothesis that a single daily administration of cefazolin and probenecid and a single daily administration of ceftriaxone and probenecid would be equally effective, in combination with oral antibiotics, for the outpatient treatment of skin and soft tissue infections, a randomized, double-blind study was completed. Patients presenting to the Emergency Department with the primary diagnosis of cellulitis or soft tissue infection, excluding patients requiring immediate hospital admission, received either 2 g of ceftriaxone or 2 g of cefazolin, each with 1 g of probenecid, on a daily basis as outpatients from the Emergency Department. The patients were given a prescription for oral penicillin and cloxacillin for independent procurement. Outcome was assessed based on reduction in the size of the infected area, and the need for additional treatment (other antibiotics or hospital admission). A total of 194 patients were randomized to receive ceftriaxone (96) or cefazolin (98). There was no statistical difference in cause of infection, site of infection, duration of treatment, noncompliance or need for incision or drainage of the wound. The outcome, as determined by the ratio of the involved infected area on initial and last treatment day, and the frequency of failure were similar. The single daily administration of 2 g of either cefazolin, in combination with probenecid, or ceftriaxone are equivalent in efficacy in the outpatient treatment of skin and soft tissue infections. There is the potential for significant cost savings in utilizing outpatient cefazolin therapy over ceftriaxone for treatment of these infections.