Two antibiotics equally effective for uncomplicated skin infections

Two antibiotics – clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX) combination – were equally effective in treating uncomplicated skin infections both in children and adults, a randomized controlled trial has shown.

The proportion of patients cured was similar for clindamycin and TMP-SMX both in the intent-to-treat population (80.3 vs 77.7 percent; p=0.52) and in patients treated (89.5 vs 88.2 percent; p=0.77). The cure rates also did not differ significantly between clindamycin and TMP-SMX in the subgroups of patients with abscesses and vasculitis. [N Engl J Med 2015;372:1093-1103]

The study included 524 adults and children with uncomplicated skin infections (cellulitis, abscesses >5 cm in diameter, or both). Abscesses were incised and drained. Patients were then randomized to receive clindamycin 150 mg thrice daily or a combination of TMP (160 mg) and SMX (800 mg) twice daily for 10 days. Paediatric doses were titrated to body weight. Cultures from 296 patients were tested and Staphylococcus aureus (S. aureus) were found in 217 patients. The primary outcome of clinical cure 7 to 10 days after the end of treatment did not differ significantly between the clindamycin and TMP-SMX treated groups.  Adverse events were also similar in both groups.

The findings suggest that uncomplicated skin infections acquired outside of hospitals can be treated successfully and cost-effectively with either antibiotic, said researchers.

Skin infection is a common medical condition accounting for approximately 14.2 million outpatient visits and more than 850,000 hospitalizations in the US in 2005.  Cases have been reported in athletes, daycare children, students, military workers and prisoners. The most common pathogen is methicillin-resistant S.aureus (MRSA). If left untreated, the condition can lead to hospitalization, surgical procedures, bacteraemia and in severe cases, death.

There were concerns as to how best to treat community-associated MRSA (CA-MRSA). Clindamycin and TMP-SX are two antibiotics recommended against CA-MRSA but have since gone off- patent.

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