Secondary prevention of cellulitis: A systematic review

ObjectivesCellulitis is a common and often recurrent bacterial skin infection. Antibiotics are the first-line treatment for cellulitis and antibiotic prophylaxis is a known preventive measure for frequent recurrence. Evidence for other interventions targeting known risk factors (secondary prevention) remains unclear. This review evaluates the evidence for managing risk factors to prevent recurrent limb cellulitis.Study designA systematic review of studies on cellulitis risk factor management, excluding antibiotic prophylaxis, was conducted. Five databases were searched in February 2023 and June 2024. Eligible studies underwent narrative synthesis and quality assessment. Databases searched included MEDLINE, Scopus, Web of Science, CINAHL, and EMBASE, for the time period 1996-June 2024.Data synthesisSummary of major results; Of 1,116 screened papers, 25 met the criteria. Study designs varied, with only one randomized controlled trial. Nearly all studies addressed lymphoedema, showing that its management, particularly with compression, consistently reduced cellulitis recurrence. Although cellulitis guidelines detail the need to address many risk factors to reduce cellulitis, including tinea and ulcers, we did not find studies that linked the management of these conditions with cellulitis recurrence.ConclusionsEvidence strongly supports lymphoedema management in preventing cellulitis recurrence, studies on other risk factors including skin integrity, are lacking. Studies to support strategies beyond antibiotic prophylaxis are needed.