{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T19:03:51Z","timestamp":1784574231374,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lower limb cellulitis accounts for 1.5%\u20132% of visits to Australasian emergency departments. Antibiotics are considered the cornerstone of management, but despite prioritisation by consumers, acute interventions to manage pain and inflammation and cellulitis recurrence prevention strategies remain understudied beyond small pilot trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We aimed to assess clinicians' current practices, areas of clinical uncertainty and willingness to randomise patients to interventions, including demarcation lines, non\u2010steroidal anti\u2010inflammatory drugs (NSAIDs), corticosteroids, compression therapy, exercise, antibiotic prophylaxis and a hypothetical streptococcal vaccine for cellulitis prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross\u2010sectional online survey, consisting of 22 questions assessing clinical practices and equipoise for randomisation into a future trial, was distributed to practicing Australasian clinicians specialising in infectious diseases, lymphoedema physiotherapy, internal medicine, emergency medicine or surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 250 (response rate of ~10%) respondents completed the survey from 77 unique institutions. Lower limb cellulitis was common, with 91 respondents reporting &gt;200 presentations at their institution annually. For most assessment, management and prevention strategies, there was wide variation in clinical practice. Overall, respondents were comfortable considering randomising to possible interventions including drawing (or removing) a line around cellulitis (91.3%), NSAIDs (90.2%) or corticosteroids (74.2%), acute compression (90.7%), exercise (96.4%) and prevention strategies such as injectable benzathine penicillin G (BPG; 87.2%) or a hypothetical streptococcal vaccine (92.7%). Most (62%) respondents expressed interest in a clinical trial of lower limb cellulitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Novel interventions for acute management and secondary prevention of cellulitis have clinical equipoise. A large, multicentre cellulitis trial is likely to be feasible in Australasian hospitals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/imj.70578","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T18:33:19Z","timestamp":1784572399000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management and prevention of lower leg cellulitis: a survey assessing practice variation and equipoise among Australasian clinicians in preparation for a randomised clinical trial"],"prefix":"10.1111","author":[{"given":"Laurens","family":"Manning","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Fiona Stanley Hospital  Perth Western Australia Australia"},{"name":"Medical School University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua Saul","family":"Davis","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research and Charles Darwin University  Darwin Northern Territory Australia"},{"name":"Department of Infectious Diseases John Hunter Hospital  Newcastle New South Wales Australia"},{"name":"School of Medicine and Public Health University of Newcastle  Newcastle New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Cutfield","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Health New Zealand Te Whatu Ora Counties Manukau  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Hills","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Health New Zealand Te Toka Tumai Auckland  Auckland New Zealand"},{"name":"Medical Research Institute of New Zealand  Wellington New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciselle","family":"Meier","sequence":"additional","affiliation":[{"name":"Emergency Department Sir Charles Gairdner Hospital  Perth Western Australia Australia"},{"name":"Discipline of Emergency Medicine The University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Ang","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy Fiona Stanley Hospital  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fergus","family":"Hamilton","sequence":"additional","affiliation":[{"name":"MRC Integrative Epidemiology Unit University of Bristol  Bristol UK"},{"name":"Microbiology Department University Hospitals Bristol and Weston NHS Foundation Trust  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Celenza","sequence":"additional","affiliation":[{"name":"Emergency Department Sir Charles Gairdner Hospital  Perth Western Australia Australia"},{"name":"Discipline of Emergency Medicine The University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Raby","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Fiona Stanley Hospital  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Hand","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Fiona Stanley Hospital  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Cross","sequence":"additional","affiliation":[{"name":"Centre of Infection and Antimicrobial Research (CINAMR) Brighton and Sussex Medical School  Brighton UK"},{"name":"Department of Infection University Hospitals Sussex NHS Foundation Trust  Brighton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Webb","sequence":"additional","affiliation":[{"name":"Clinical Hub for Interventional Research (CHOIR) John Curtin School of Medical Research, Australian National University  Canberra Australian Capital Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofae272","article-title":"Serological responses to Streptococcus pyogenes vaccine candidate antigens suggests that Streptococcus dysgalactiae is the predominant cause of lower limb cellulitis","volume":"11","author":"Taggart M","year":"2024","journal-title":"Open Forum Infect 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