April 1, 2015
What’s Best for Skin Infections? Clindamycin or TMP-SMX?

Los Angeles—Does clindamycin or trimethoprim–sulfamethoxazole (TMP-SMX) work better in outpatients with uncomplicated skin infections who had cellulitis, abscesses generally larger than 5 cm in diameter, or both?

That’s what a study led by researchers from Los Angeles Biomedical Research Institute and Division of Infectious Diseases, Harbor–UCLA Medical Center sought to find out. Their results were published recently in the New England Journal of Medicine.

Background information in the articles notes that, while skin and skin-structure infections are common in ambulatory settings, “the efficacy of various antibiotic regimens in the era of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is unclear.”

To help formulate an answer, the researchers enrolled patients at four study sites, with all abscesses undergoing incision and drainage. The 542 patients—including 155 children—were then randomly assigned, with about half receiving clindamycin and the rest getting TMP-SMX for 10 days. The primary outcome was clinical cure 7 to 10 days after the end of treatment.

Of the patients, 160 had an abscess, 280 had cellulitis, and 82 had mixed infection, defined as at least one abscess lesion and one cellulitis lesion. With S. aureus isolated from the lesions of 41.7% of the patients, 77% of those were MRSA.

Results indicate that the proportion of patients cured was similar in the two treatment groups. “Cure rates did not differ significantly between the two treatments in the subgroups of children, adults, and patients with abscess versus cellulitis. The proportion of patients with adverse events was similar in the two groups,” the authors report.

One of the strengths of the study, the researchers point out, is that it “included both adults and children, which is of critical importance given that skin infections are highly prevalent among persons of all ages.” The authors also emphasize that their study group was ethnically and geographically diverse.

“We found no significant difference between clindamycin and TMP-SMX, with respect to either efficacy or side-effect profile, for the treatment of uncomplicated skin infections, including both cellulitis and abscesses,” the study concludes.
U.S. Pharmacist Social Connect