Open Access Open Badges Study protocol

Comparing short to standard duration of antibiotic therapy for patients hospitalized with cellulitis (DANCE): study protocol for a randomized controlled trial

Duncan R Cranendonk12*, Brent C Opmeer3, Jan M Prins2 and W Joost Wiersinga12

Author Affiliations

1 Center for Experimental and Molecular Medicine (CEMM), Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 9, room G2-130, 1105 AZ, Amsterdam, The Netherlands

2 Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands

3 Clinical Research Unit, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands

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BMC Infectious Diseases 2014, 14:235  doi:10.1186/1471-2334-14-235

Published: 5 May 2014



Recommended therapy duration for patients hospitalized with cellulitis is 10–14 days. Unnecessary use of antibiotics is one of the key factors driving resistance. Recent studies have shown that antibiotic therapy for cellulitis in outpatients can safely be shortened, despite residual inflammation. This study will compare in hospitalized patients the safety and effectiveness of shortening antibiotic therapy for cellulitis from 12 to 6 days.


In a multicenter, randomized, double-blind, non-inferiority trial, adult patients admitted with cellulitis will be included. Cellulitis is defined as warmth, erythema, and induration of the skin and/or subcutaneous tissue, with or without pain (including erysipelas). All patients will initially be treated with intravenous flucloxacillin, and will be evaluated after 5–6 days. Those who have improved substantially (defined as being afebrile, and having a lower cellulitis severity score) will be randomized at day 6 between additional 6 days of oral flucloxacillin (n = 198) or placebo (n = 198). Treatment success is defined as resolution of cellulitis on day 14 (disappearance of warmth and tenderness, improvement of erythema and edema), without the need of additional antibiotics for cellulitis by day 28. Secondary endpoints are relapse rate (up to day 90), speed of recovery (using a cellulitis severity score until day 28, and VAS scores on pain and swelling until day 90), quality of life (using the SF-36 and EQ-5D questionnaires) and costs (associated with total antibiotic use and health-care resource utilization up to day 90).


Inclusion is planned to start in Q2 2014.

Trial registration (NCT02032654) and the Netherlands Trial Register (NTR4360).

Cellulitis; Erysipelas; Skin infections; Antibiotics; Flucloxacillin; Therapy duration; Hospital setting; Randomised controlled trial