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Cross-sectionalInternal medicine journal · 2026

Management and prevention of lower leg cellulitis: a survey assessing practice variation and equipoise among Australasian clinicians in preparation for a randomised clinical trial.

Laurens Manning, Joshua Saul Davis, Timothy Cutfield … Elizabeth Webb

Emergency MedicineCross-sectional

Most Australasian clinicians are interested in a lower limb cellulitis clinical trial.

Management and prevention of lower leg cellulitis: a survey assessing practice variation and equipoise among Australasian clinicians in preparation for a randomised clinical trial.

Laurens Manning et al. · Internal medicine journal · 2026

Background

Lower limb cellulitis accounts for 1.5%-2% of visits to Australasian emergency departments.

Purpose

We aimed to assess clinicians' current practices, areas of clinical uncertainty and willingness to randomise patients to interventions, including demarcation lines, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, compression therapy, exercise, antibiotic prophylaxis and a hypothetical streptococcal vaccine for cellulitis prevention.

Methods

A cross-sectional 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.

Results

most clinicians were interested in a research study for lower leg skin infection

More results

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 >200 presentations at their institution annually.

For most assessment, management and prevention strategies, there was wide variation in clinical practice.

More results

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%).

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Conclusion

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.

Post

Management and prevention of lower leg cellulitis: a survey assessing practice variation and equipoise among Australasian clinicians in preparation for a randomised clinical trial.

Most Australasian clinicians are interested in a lower limb cellulitis clinical trial.

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