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Better outcomes with I&D plus antibiotics for simple skin abscesses

AbscessMethicillin-resistant Staphylococcus aureus (MRSA) bacteria are resistant to multiple antibiotics and commonly cause skin infections that can lead to more serious or life-threatening infection in other parts of the body. Researchers have now found that two common, inexpensive antimicrobials can help patients heal from MRSA skin abscesses.

The findings suggest that current treatment options for MRSA still have a role, even as scientists continue to search for new antimicrobial products. The research was funded by the National Institute of Allergy and Infectious Diseases (NIAID), a part of the National Institutes of Health (NIH).

The study was conducted at hospitals across the US and involved 796 children and adults with small, uncomplicated skin abscesses. All patients had their abscesses opened and drained as part of standard MRSA treatment. The patients were then sorted into three groups, each of which received a different, ten-day oral treatment regimen. One group received clindamycin, a second group received trimethoprim-sulfamethoxazole (TMP-SMX), and the third group received placebo.

The group treated with clindamycin had an 81.7% cure rate, and the group that received TMP-SMX had an 84.6% cure rate. The placebo group had a 62.9% cure rate. According to the researchers, the findings contradict a commonly held belief that antimicrobial treatment is little better than doing nothing for MRSA skin infections. It corroborates the findings of another NIAID-funded study demonstrating that TMP-SMX treatment resulted in better clinical outcomes than placebo for MRSA skin abscesses, and also upholds other findings that both clindamycin and TMP-SMX are equally beneficial in treating MRSA skin infections.

The researchers note, however, that the side effects of clindamycin and TMP-SMX (including nausea, diarrhea, and possible new Clostridium difficile infections) can be severe. In addition, some strains of Staphylococcus are resistant to clindamycin. The authors recommend that healthcare providers weigh the risks but not dismiss these antimicrobials out of hand as viable treatment options for MRSA skin abscesses.

Abstract
Background: Uncomplicated skin abscesses are common, yet the appropriate management of the condition in the era of community-associated methicillin-resistant Staphylococcus aureus (MRSA) is unclear.
Methods: We conducted a multicenter, prospective, double-blind trial involving outpatient adults and children. Patients were stratified according to the presence of a surgically drainable abscess, abscess size, the number of sites of skin infection, and the presence of nonpurulent cellulitis. Participants with a skin abscess 5 cm or smaller in diameter were enrolled. After abscess incision and drainage, participants were randomly assigned to receive clindamycin, trimethoprim–sulfamethoxazole (TMP-SMX), or placebo for 10 days. The primary outcome was clinical cure 7 to 10 days after the end of treatment.
Results: We enrolled 786 participants: 505 (64.2%) were adults and 281 (35.8%) were children. A total of 448 (57.0%) of the participants were male. S. aureus was isolated from 527 participants (67.0%), and MRSA was isolated from 388 (49.4%). Ten days after therapy in the intention-to-treat population, the cure rate among participants in the clindamycin group was similar to that in the TMP-SMX group (221 of 266 participants [83.1%] and 215 of 263 participants [81.7%], respectively; P=0.73), and the cure rate in each active-treatment group was higher than that in the placebo group (177 of 257 participants [68.9%], P Conclusions: As compared with incision and drainage alone, clindamycin or TMP-SMX in conjunction with incision and drainage improves short-term outcomes in patients who have a simple abscess. This benefit must be weighed against the known side-effect profile of these antimicrobials.

Authors
Robert S Daum, Loren G Miller, Lilly Immergluck, Stephanie Fritz, C Buddy Creech, David Young, Neha Kumar, Michele Downing, Stephanie Pettibone, Rebecca Hoagland, Samantha J Eells, Mary G Boyle, Trisha Chan Parker, Henry F Chambers

[link url="https://www.sciencedaily.com/releases/2017/06/170629142704.htm"]NIH/National Institute of Allergy and Infectious Disease material[/link]
[link url="http://www.nejm.org/doi/10.1056/NEJMoa1607033"]New England Journal of Medicine abstract[/link]

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