Does Antibiotic Choice Matter for SSTIs?
Does Antibiotic Choice Matter for SSTIs?
Miller LG, Daum RS, Creech CB, et al; DMID 07-0051 Team
N Engl J Med. 2015;372:1093-1103
This report details the outcomes of a randomized clinical trial of patients treated for skin infections. All patients had cellulitis or abscesses, or both, clinically diagnosed at least 24 hours before enrollment. The patients were enrolled at urgent care facilities and outpatient clinics in four cities in the United States from 2009 through 2011.
Patients were excluded if a human or animal bite was the cause of the infection, if they had an oral temperature > 101.3°F (or > 100.4°F in children aged 6-11 months), if they were on immunosuppressive medications, or if they had an immune-compromising medical condition. There were further exclusion criteria to preclude enrollment of patients who might be at higher risk for complicated skin infections.
The outcomes of patients with cellulitis or abscesses > 5 cm (the larger abscess/cellulitis group) are reported. All abscesses were drained. After drainage of the abscess, the patients were randomly assigned in a 1:1 ratio to receive the two study drugs. The clindamycin group received an appropriate dose three times each day. The trimethoprim/sulfamethoxazole (TMP-SMX) group received the drug twice daily, with a placebo dose given at midday.
Doses were weight-based, and liquid formulations were used if needed. Pills and liquid formulations were both masked to obscure identification of the treatment group.
Available skin fluids or exudates were cultured for attempted identification of organisms. Investigators were masked to microbiology outcomes during the study.
Patients were evaluated during a visit that occurred 7-10 days after completion of antibiotic therapy (the "test of cure" visit), and at 1-month follow-up. The following were considered treatment failures: presence of an active lesion at the test-of-cure visit, discontinuation of study antibiotic within the first 48 hours owing to side effects, a skin infection at a different body site, further surgical treatment of the infection, or hospitalization because of the infection.
Clindamycin Versus Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Infections
Miller LG, Daum RS, Creech CB, et al; DMID 07-0051 Team
N Engl J Med. 2015;372:1093-1103
Study Summary
This report details the outcomes of a randomized clinical trial of patients treated for skin infections. All patients had cellulitis or abscesses, or both, clinically diagnosed at least 24 hours before enrollment. The patients were enrolled at urgent care facilities and outpatient clinics in four cities in the United States from 2009 through 2011.
Patients were excluded if a human or animal bite was the cause of the infection, if they had an oral temperature > 101.3°F (or > 100.4°F in children aged 6-11 months), if they were on immunosuppressive medications, or if they had an immune-compromising medical condition. There were further exclusion criteria to preclude enrollment of patients who might be at higher risk for complicated skin infections.
The outcomes of patients with cellulitis or abscesses > 5 cm (the larger abscess/cellulitis group) are reported. All abscesses were drained. After drainage of the abscess, the patients were randomly assigned in a 1:1 ratio to receive the two study drugs. The clindamycin group received an appropriate dose three times each day. The trimethoprim/sulfamethoxazole (TMP-SMX) group received the drug twice daily, with a placebo dose given at midday.
Doses were weight-based, and liquid formulations were used if needed. Pills and liquid formulations were both masked to obscure identification of the treatment group.
Available skin fluids or exudates were cultured for attempted identification of organisms. Investigators were masked to microbiology outcomes during the study.
Patients were evaluated during a visit that occurred 7-10 days after completion of antibiotic therapy (the "test of cure" visit), and at 1-month follow-up. The following were considered treatment failures: presence of an active lesion at the test-of-cure visit, discontinuation of study antibiotic within the first 48 hours owing to side effects, a skin infection at a different body site, further surgical treatment of the infection, or hospitalization because of the infection.
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