Penicillin has been used as long-term medication for many
years in other conditions such as rheumatic fever, and group
A streptococcus has remained susceptible to penicillin for over
60 years without signs of developing resistance.30 It therefore
represents a very cheap intervention (£18 per 6-month
course) that has potential for substantial health savings.
Assuming a NNT of 8, this equates to a treatment cost of
£144 per episode of cellulitis prevented.
It is disappointing that the trial failed to achieve its recruitment
target of 400 participants and thus failed to provide sufficient
evidence on which to base firm conclusions.
Nevertheless, the trial does suggest a potentially large protective
effect that was consistent throughout the follow-up
period, and robust in sensitivity analysis.