{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T02:51:11Z","timestamp":1789527071797,"version":"build-2803163510"},"reference-count":31,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["PB-PG-0212-27015"],"award-info":[{"award-number":["PB-PG-0212-27015"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,12,21]]},"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare flucloxacillin with clindamycin to flucloxacillin alone for the treatment of limb cellulitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Parallel, double-blinded, randomised controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Emergency department attendances and general practice referrals within 20 hospitals in England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Flucloxacillin, at a minimum of 500\u2005mg 4 times per day for 5\u2005days, with clindamycin 300\u2005mg 4 times per day for 2\u2005days given orally versus flucloxacillin given alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was improvement at day 5. This was defined as being afebrile with either a reduction in affected skin surface temperature or a reduction in the circumference of the affected area. Secondary outcomes included resolution of systemic features, resolution of inflammatory markers, recovery of renal function, reduction in the affected area, decrease in pain, return to work or normal activities and the absence of increased side effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>410 patients were included in the trial. No significant difference was seen in improvement at day 5 for flucloxacillin with clindamycin (136\/156, 87%) versus flucloxacillin alone (140\/172, 81%)\u2014OR 1.55 (95% CI 0.81 to 3.01), p=0.174. There was a significant difference in the number of patients with diarrhoea at day 5 in the flucloxacillin with clindamycin allocation (34\/160, 22%) versus flucloxacillin alone (16\/176, 9%)\u2014OR 2.7 (95% CI 1.41 to 5.07), p=0.002. There was no clinically significant difference in any secondary outcome measures. There was no significant difference in the number of patients stating that they had returned to normal activities at the day 30 interview in the flucloxacillin with clindamycin allocation (99\/121, 82%) versus flucloxacillin alone (104\/129, 81%)\u2014adjusted OR 0.90 (95% CI 0.44 to 1.84).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The addition of a short course of clindamycin to flucloxacillin early on in limb cellulitis does not improve outcome. The addition of clindamycin doubles the likelihood of diarrhoea within the first few days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01876628\" ext-link-type=\"uri\">NCT01876628<\/jats:ext-link>\n                      , Results.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-013260","type":"journal-article","created":{"date-parts":[[2017,3,17]],"date-time":"2017-03-17T23:58:34Z","timestamp":1489795114000},"page":"e013260","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":46,"title":["Adjunctive clindamycin for cellulitis: a clinical trial comparing flucloxacillin with or without clindamycin for the treatment of limb cellulitis"],"prefix":"10.1136","volume":"7","author":[{"given":"Richard","family":"Brindle","sequence":"first","affiliation":[{"name":"Microbiology and Infectious Diseases, Bristol Royal Infirmary, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O Martin","family":"Williams","sequence":"additional","affiliation":[{"name":"Microbiology and Infectious Diseases, Bristol Royal Infirmary, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Davies","sequence":"additional","affiliation":[{"name":"General Practice Support Unit, Bristol Royal Infirmary, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Royal London Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Jarman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, St George's University Hospitals, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair D","family":"Hay","sequence":"additional","affiliation":[{"name":"Centre for Academic Primary Care, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Featherstone","sequence":"additional","affiliation":[{"name":"Acute Medicine Unit, Queen Alexandra Hospital, Portsmouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,3,17]]},"reference":[{"key":"2025121601242348000_7.3.e013260.1","doi-asserted-by":"crossref","first-page":"163.e1","DOI":"10.1016\/j.jaad.2012.03.024","article-title":"Lower limb cellulitis and its mimics: part I. 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