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Clindamycin, TMP-SMX are equally effective for skin infections

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Reassuring findings for most patients

“Given the immense importance of MRSA infections during the past 20 years, prospective clinical trial data to inform the choice of outpatient treatment of skin infections are surprisingly sparse,” according to Dr. Michael R. Wessels. The findings of Miller et al. reassure that outcomes are good for most such patients when they are treated with either of the two most popular agents, he noted in an accompanying editorial.

But carefully designed clinical trials like this one are still needed to determine which therapies are most effective and safe for cellulitis and skin abscesses in patients who are more severely ill, such as those who have high fever or lymphangitis, as well as for patients who have coexisting conditions such as diabetes, cancer, or obesity, Dr. Wessels wrote.

Dr. Michael R. Wessels is a member of the division of infectious diseases at Boston Children’s Hospital and in the department of pediatrics at Harvard Medical School, Boston. He reported having no financial disclosures. Dr. Wessels made these remarks in an editorial accompanying Dr. Miller’s report (N. Engl. J. Med. 2015;372:1164-65 [doi:10.1056/NEJMe1500331]).


 

References

Clindamycin and trimethoprim-sulfamethoxazole are similarly safe and effective for treating uncomplicated skin infections, including both cellulitis and abscesses, in ambulatory settings in regions where MRSA is endemic, according to a report published online March 19 in the New England Journal of Medicine.

The data comparing these two agents in an ambulatory setting are limited, though both are commonly recommended as empirical therapy for skin infections in patients who present to clinics and emergency departments and have only minor or no coexisting conditions, said Dr. Loren G. Miller of the Los Angeles Biomedical Research Institute and the division of infectious diseases at Harbor-UCLA Medical Center, and his associates.

© Photo Researchers/NHGRI

They performed a prospective double-blind randomized trial comparing clindamycin against TMP-SMX in 524 ethnically diverse adults and children who presented as outpatients with uncomplicated skin infections during a 2-year period in Chicago, San Francisco, Los Angeles, and Nashville – areas in which community-associated MRSA is endemic. The mean patient age was 27 years, and approximately 30% were pediatric patients. All the participants had cellulitis without abscesses (including erysipelas), one or more abscesses larger than 5 cm in diameter, or both conditions. A total of 264 were randomized to clindamycin and 260 to TMP-SMX daily for 10 days.

Cure rates did not differ significantly between the two study groups. At 7-10 days after completing therapy, the rates of cure in the intention-to-treat population were 80.3% for clindamycin and 77.7% for TMP-SMX, and in the evaluable population the rates were 89.5% and 88.2%, respectively.

At 1 month follow-up, the cure rates in the evaluable population were 83.9% for clindamycin and 78.2% for TMP-SMX, the investigators said (N. Engl. J. Med. 2015;372:1093-103 [doi:10.1056/NEJMoa1403789]). Rates of adverse events were nearly identical between the two study groups (18.9% vs. 18.6%), and most were mild and resolved without sequelae. There were no treatment-associated serious adverse events, and the rates of treatment discontinuation were very similar between patients receiving clindamycin (8.3%) and those receiving TMP-SMX (8.8%).

The study was supported by grants from the National Institutes of Allergy and Infectious Diseases. Dr. Miller reported receiving consulting fees from Cubist, Durata, and Pfizer; his associates reported ties to Cubist, Pfizer, EMMES, Theravance, AstraZeneca, Trius, Merck, and Cerexa.

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