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Antibiotic Regimens Compared for Treating Uncomplicated Skin Infections


Clinical question: What are the efficacy and safety of clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX) for treatment of uncomplicated soft tissue infections in adults and children?

Background: Clindamycin and TMP-SMX are commonly used treatments for uncomplicated skin infections in adults and children, but no head-to-head comparison of efficacy or side effect profile for these medications exists.

Study design: Multi-center, prospective, double-blind, randomized clinical trial of superiority.

Setting: Four academic medical centers.

Synopsis: A group of 524 adults (n=369) and children with uncomplicated cellulitis, abscess, or both was enrolled. For patients with abscess, only those with larger lesions (based on age) were included. All abscesses were incised and drained, and patients were randomly treated with either clindamycin or TMP-SMX for 10 days. A total of 41% of cultures from suppurative wounds grew Staphylococcus aureus; 77% of these were methicillin-resistant.

The primary outcome was clinical cure assessed at 7 to 10 days and one month after completing treatment. No significant difference in cure or reported side effects was seen between drug treatment groups, age groups, lesion types, or isolates cultured. Some 80.3% of patients in the clindamycin group and 77.3% of patients in the TMP-SMX group were cured. Side effect profiles assessed by patient questionnaires showed similar rates of self-limited gastrointestinal (~19%) and dermatologic (~1%) complaints. No cases of Clostridium difficile–associated diarrhea were found.

Limitations include exclusion of patients with significant comorbidities and hospitalized patients. Also, other antibiotic regimens were not compared. Patients were followed for only one month to assess recurrence. Finally, no attempt was made to optimize antibiotic dose.

Bottom line: Clindamycin and TMP-SMX had similar cure rates and side effect profiles in otherwise healthy patients with uncomplicated skin infections.

Citation: Miller LG, Daum RS, Creech CB, et al. Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections. N Engl J Med. 2015;372:1093–1103.

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