World-first trial has potential to change treatment guidelines for children with cellulitis

By: Avant Media

Feb 12, 2016

Dr Laila Ibrahim has been awarded a full-time scholarship under Avant’s Doctor in Training Research Scholarship Program 2015 to lead the world’s first randomised controlled trial to explore the hypothesis that children with cellulitis can effectively and safely be treated at home with antibiotics.   

A paediatric registrar and part-time Community and Child Health Fellow at The Royal Children’s Hospital Melbourne, Dr Ibrahim’s passion for paediatrics ignited when she first stepped onto a children’s ward while completing her medical degree in Dublin.  

“I thought ‘This is it – I would like to come in and do this every day,’” she says.

Dr Ibrahim (pictured), 34, who moved to Melbourne in 2012 with her husband, a neonatology fellow, after seeing the ‘capital of cool’ advertised on TV, has forged a successful career as a researcher, clinician and educator.

Benefits of treating children at home

Dr Ibrahim will use the Avant scholarship to complete the third stage of the CHOICE (Cellulitis: Home Or Inpatient in Children from Emergency) project as part of her Doctor of Medical Science degree at the University of Melbourne.

The idea for developing the direct-from-emergency department-to-home pathway germinated while working as a ‘Hospital-In-The-Home’ (HITH) registrar at the Royal Children’s Hospital Melbourne, she says.  

“I would treat the children in their homes as opposed to on the hospital ward, so I saw firsthand the advantages of treating a child in their own bed,” she says.

“We know that children with chronic health care needs treated at home have better psychological outcomes, are less exposed to hospital-acquired infections, have less adverse events and there is less disruption to family life. We believed this could be extrapolated to all children.”

‘Bringing the hospital to the child’ vision to life   

Expanding on the HITH concept, Dr Ibrahim was instrumental in the formation of the CHOICE team involving key clinicians at The Royal Children’s Hospital Melbourne. The experienced team includes her mentor, A/Prof Penelope Bryant, Infectious Diseases Physician and Head of the HITH, Prof Nigel Curtis, Head of Infectious Diseases, A/Prof Franz Babl, Director of Emergency Research, Dr Sandy Hopper, an emergency physician and Dr Tom Connell, Director of General Medicine.

Results from the first stage of the CHOICE project, a published prospective observational study which Dr Ibrahim led comparing home IV ceftriaxone versus standard treatment with inpatient IV flucloxacillin in 144 children with cellulitis has provided pilot data for the current trial. The results were positive, showing that the duration of antibiotics (home 2.3 daysversus inpatient 2.5 days) and the length of stay (2.7 days in both groups) under medical care were similar in both treatment groups.

As the principal investigator for the CHOICE trial, Dr Ibrahim will compare the safety and efficacy of once daily home IV ceftriaxone versus inpatient IV flucloxacillin in 188 children aged six months to 18 years who present to The Royal Children’s Hospital’s emergency department with moderate to severe cellulitis

“The primary outcome is lack of improvement within 48 hours which usually results in a change of antibiotics meaning that the children would have to come into hospital,” she says.

Secondary outcomes include readmission to hospital, adverse events, length of stay, economic evaluation of cost effectiveness and patient/parent satisfaction.

A comparison of the clinical effects of ceftriaxone and flucloxacillin on children’s gut microbiota will also form a key component of the trial.

“In some situations ceftriaxone has been associated with increased resistance in bacteria, so providing conclusive evidence whether or not short-term use has this effect in healthy children will be a significant finding,” Dr Ibrahim says.   

Treatment of cellulitis is the tip of the iceberg  

With a view to publishing the results in early 2017, Dr Ibrahim believes the research will have significant practice implications.    

"If this study shows that once daily ceftriaxone at home is a safe and effective way to treat moderate/severe cellulitis, the benefits in quality of life for children and their families and cost effectiveness will lead to this becoming the standard of care and change clinical practice,” she says.  

However, Dr Ibrahim says the use of home antibiotics for cellulitis is just the tip of iceberg, with the research potentially having broader implications for the treatment of many other common medical conditions.  

Scholarship allows undivided focus to increase research quality

Dr Ibrahim said she was delighted to win the Avant Doctor in Training Research Scholarship as it lends weight to her research and will allow her to focus on the research full-time.  

“Having that external body support you gives so much credibility to the research itself and to the researcher. I think having that line on my CV that I’ve had support from Avant is going to go a long, long way,” she says. 

“The scholarship has also been crucial to allow me to focus entirely on clinical and laboratory research for the tenure of my postgraduate degree which will also increase the quality of the research.”

Does your research deserve funding? 

Applications for the 2016 Avant Doctor in Training Research Scholarship Program are now open. Twenty-two scholarships are available – more than any other year to date – worth $450,000, for both emerging and experienced researchers.

Apply online on the Avant website or for more information download our Information Pack.

If you have any questions, please contact the DiT Research Scholarship team at scholarship@avant.org.au. Applications close 31 May 2016.