Elizabeth Webb, M.P.H Physiotherapy Department Calvary Public Hospital Bruce Bruce, Australia

NEJM: Compression Therapy Prevention of Recurrent Cellulitis Without Antibiotics

MedicalResearch.com Interview with:

Elizabeth Webb, M.P.H Physiotherapy Department Calvary Public Hospital Bruce Bruce, Australia

Elizabeth Webb

Elizabeth Webb, M.P.H
Physiotherapy Department
Calvary Public Hospital Bruce
Bruce, Australia

MedicalResearch.com: What is the background for this study?

Response: Our study showed that in patients with a history of leg swelling (chronic edema), compression therapy by a skilled lymphedema therapist reduced the risk of infection in the leg (cellulitis) by a huge 77%. With up to 47% of patients experiencing recurrence of cellulitis in their legs within 3 years, this result is a game-changer in terms of our approach to managing patients with leg swelling and recurrent cellulitis.

Until now, the use of prophylactic antibiotics to prevent cellulitis has been the only evidence-based practice. We know however, there are many reasons why avoidance of antibiotics is important within our community.

MedicalResearch.com: What are the main findings?

Response: We are thrilled to have provided strong evidence that antibiotics are not the only way – and are perhaps not even the best way – to prevent recurrent leg cellulitis in these patients. Our study reduced risk of cellulitis by 77%, whereas randomized trials of antibiotics have reported reductions of 45% at best. Further, compression therapy has minimal side effects, and was well-tolerated by patients in our study. We hope that the main findings of our study will mean a shift towards prophylactic compression therapy for patients with chronic leg swelling and recurrent cellulitis. Not only would this reduce pain and suffering for patients, it could have a major impact on healthcare costs as well, as so many patients require hospitalization for cellulitis in their legs. 

MedicalResearch.com: What should readers take away from your report?

Response: In patients with chronic edema and recurrent cellulitis in their leg, doctors should refer patients to specialized lymphedema therapists for compression therapy. This will not only lead to improvement in the patient’s leg swelling, but also significantly reduce their risk of future skin infections. Skilled lymphedema therapists will guide patients through this pathway with individualized compression therapy prescription and education.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Future research should explore and compare the costs related to cellulitis and compression therapy. If compression therapy proves to be cost effective this will further justify translation of these results to clinical practice around the world. This analysis is under way, and we look forward to sharing the results in the near future.  ​ 


Compression Therapy to Prevent Recurrent Cellulitis of the Leg

Elizabeth Webb, M.P.H., Teresa Neeman, Ph.D., Francis J. Bowden, M.D., Jamie Gaida, Ph.D., Virginia Mumford, Ph.D., and Bernie Bissett, Ph.D.
August 13, 2020 N Engl J Med 2020; 383:630-639 DOI: 10.1056/NEJMoa1917197 


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Last Updated on August 12, 2020 by Marie Benz MD FAAD