Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin
infections.
Author(s): Miller LG(1), Daum RS, Creech CB, Young D, Downing MD, Eells SJ, Pettibone S,
Hoagland RJ, Chambers HF; DMID 07-0051 Team.
Collaborators: Young D, Campbell A, Hansen S, Rodriguez R, Cohen M, Zeitschel D,
Volinski J, Young K, Munekata M, McKinnell J, Bolaris M, Sharp L, Klein S, Dubria
M, Manai L, Tanoviceanu R, Nazarians A, Flores M, Alegria I, Tagudar G, Correa R,
Tetangco D, Sullivan D, Silverstein T, Kumar N, Self W, Williams D, Thomsen I,
Toney M, Johnson G, Phillips S, Fox S.
Affiliation(s): Author information:
(1)From the Los Angeles Biomedical Research Institute (L.G.M., S.J.E.) and
Division of Infectious Diseases, Harbor-UCLA (University of California, Los
Angeles) Medical Center (L.G.M., S.J.E.), Torrance, David Geffen School of
Medicine at UCLA, Los Angeles (L.G.M., S.J.E.), Division of Plastic and
Reconstructive Surgery, University of California, San Francisco (UCSF) (D.Y.),
and Division of Infectious Diseases, San Francisco General Hospital and UCSF
(M.D.D., H.F.C.), San Francisco - all in California; Division of Pediatric
Infectious Diseases, University of Chicago, Chicago (R.S.D.); Division of
Pediatric Infectious Diseases, Vanderbilt University, Nashville (C.B.C.); the
EMMES Corporation, Rockville, MD (S.P.); and Cota Enterprises, Meriden, KS
(R.J.H.).
Publication date & source: 2015, N Engl J Med. , 372(12):1093-103
BACKGROUND: Skin and skin-structure infections are common in ambulatory settings.
However, the efficacy of various antibiotic regimens in the era of
community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is unclear.
METHODS: We enrolled outpatients with uncomplicated skin infections who had
cellulitis, abscesses larger than 5 cm in diameter (smaller for younger
children), or both. Patients were enrolled at four study sites. All abscesses
underwent incision and drainage. Patients were randomly assigned in a 1:1 ratio
to receive either clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) for 10
days. Patients and investigators were unaware of the treatment assignments and
microbiologic test results. The primary outcome was clinical cure 7 to 10 days
after the end of treatment.
RESULTS: A total of 524 patients were enrolled (264 in the clindamycin group and
260 in the TMP-SMX group), including 155 children (29.6%). One hundred sixty
patients (30.5%) had an abscess, 280 (53.4%) had cellulitis, and 82 (15.6%) had
mixed infection, defined as at least one abscess lesion and one cellulitis
lesion. S. aureus was isolated from the lesions of 217 patients (41.4%); the
isolates in 167 (77.0%) of these patients were MRSA. The proportion of patients
cured was similar in the two treatment groups in the intention-to-treat
population (80.3% in the clindamycin group and 77.7% in the TMP-SMX group;
difference, -2.6 percentage points; 95% confidence interval [CI], -10.2 to 4.9;
P=0.52) and in the populations of patients who could be evaluated (466 patients;
89.5% in the clindamycin group and 88.2% in the TMP-SMX group; difference, -1.2
percentage points; 95% CI, -7.6 to 5.1; P=0.77). Cure rates did not differ
significantly between the two treatments in the subgroups of children, adults,
and patients with abscess versus cellulitis. The proportion of patients with
adverse events was similar in the two groups.
CONCLUSIONS: We found no significant difference between clindamycin and TMP-SMX,
with respect to either efficacy or side-effect profile, for the treatment of
uncomplicated skin infections, including both cellulitis and abscesses. (Funded
by the National Institute of Allergy and Infectious Diseases and the National
Center for Advancing Translational Sciences, National Institutes of Health;
ClinicalTrials.gov number, NCT00730028.).
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