Clindamycin versus Trimethoprim–Sulfamethoxazole for Uncomplicated Skin Infections. Miller, L. G.; Daum, R. S.; Creech, C. B.; Young, D.; Downing, M. D.; Eells, S. J.; Pettibone, S.; Hoagland, R. J.; and Chambers, H. F. New England Journal of Medicine, 372(12):1093–1103, March, 2015. 00000
Clindamycin versus Trimethoprim–Sulfamethoxazole for Uncomplicated Skin Infections [link]Paper  doi  abstract   bibtex   
BACKGROUND Skin and skin-structure infections are common in ambulatory settings. However, the efficacy of various antibiotic regimens in the era of community-acquired methicillinresistant Staphylococcus aureus (MRSA) is unclear. METHODS We enrolled outpatients with uncomplicated skin infections who had cellulitis, abscesses larger than 5 cm in diameter (smaller for younger children), or both. Patients were enrolled at four study sites. All abscesses underwent incision and drainage. Patients were randomly assigned in a 1:1 ratio to receive either clindamycin or trimethoprim–sulfamethoxazole (TMP-SMX) for 10 days. Patients and investigators were unaware of the treatment assignments and microbiologic test results. The primary outcome was clinical cure 7 to 10 days after the end of treatment. RESULTS A total of 524 patients were enrolled (264 in the clindamycin group and 260 in the TMP-SMX group), including 155 children (29.6%). One hundred sixty patients (30.5%) had an abscess, 280 (53.4%) had cellulitis, and 82 (15.6%) had mixed infection, defined as at least one abscess lesion and one cellulitis lesion. S. aureus was isolated from the lesions of 217 patients (41.4%); the isolates in 167 (77.0%) of these patients were MRSA. The proportion of patients cured was similar in the two treatment groups in the intention-to-treat population (80.3% in the clindamycin group and 77.7% in the TMP-SMX group; difference, −2.6 percentage points; 95% confidence interval [CI], −10.2 to 4.9; P = 0.52) and in the populations of patients who could be evaluated (466 patients; 89.5% in the clindamycin group and 88.2% in the TMP-SMX group; difference, −1.2 percentage points; 95% CI, −7.6 to 5.1; P = 0.77). 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. From the Los Angeles Biomedical Research Institute (L.G.M., S.J.E.) and Division of Infectious Diseases, Harbor–UCLA (University of California, Los Angeles) Medical Center (L.G.M., S.J.E.), Torrance, David Geffen School of Medicine at UCLA, Los Angeles (L.G.M., S.J.E.), Division of Plastic and Reconstructive Surgery, University of California, San Francisco (UCSF) (D.Y.), and Division of Infectious Diseases, San Francisco General Hospital and UCSF (M.D.D., H.F.C.), San Francisco —all in California; Division of Pediatric Infectious Diseases, University of Chicago, Chicago (R.S.D.); Division of Pediatric Infectious Diseases, Vanderbilt University, Nashville (C.B.C.); the EMMES Corporation, Rockville, MD (S.P.); and Cota Enterprises, Meriden, KS (R.J.H.). Address reprint requests to Dr. Miller at the Division of Infectious Diseases, Harbor–UCLA Medical Center, 1000 W. Carson St., Box 466, Torrance, CA 90509, or at l­gmiller@ ­ucla.­edu. *A list of additional members of the Division of Microbiology and Infectious Diseases (DMID) 07-0051 Team is provided in the Supplementary Appendix, available at NEJM.org. N Engl J Med 2015;372:1093-103. DOI: 10.1056/NEJMoa1403789 Copyright © 2015 Massachusetts Medical Society. CONCLUSIONS 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. (Funded by the National Institute of Allergy and Infectious Diseases and the National Center for Advancing Translational Sciences, National Institutes of Health; ClinicalTrials.gov number, NCT00730028.)
@article{miller_clindamycin_2015,
	title = {Clindamycin versus {Trimethoprim}–{Sulfamethoxazole} for {Uncomplicated} {Skin} {Infections}},
	volume = {372},
	issn = {0028-4793, 1533-4406},
	url = {http://www.nejm.org/doi/10.1056/NEJMoa1403789},
	doi = {10/f66b5s},
	abstract = {BACKGROUND Skin and skin-structure infections are common in ambulatory settings. However, the efficacy of various antibiotic regimens in the era of community-acquired methicillinresistant Staphylococcus aureus (MRSA) is unclear.
METHODS We enrolled outpatients with uncomplicated skin infections who had cellulitis, abscesses larger than 5 cm in diameter (smaller for younger children), or both. Patients were enrolled at four study sites. All abscesses underwent incision and drainage. Patients were randomly assigned in a 1:1 ratio to receive either clindamycin or trimethoprim–sulfamethoxazole (TMP-SMX) for 10 days. Patients and investigators were unaware of the treatment assignments and microbiologic test results. The primary outcome was clinical cure 7 to 10 days after the end of treatment.
RESULTS A total of 524 patients were enrolled (264 in the clindamycin group and 260 in the TMP-SMX group), including 155 children (29.6\%). One hundred sixty patients (30.5\%) had an abscess, 280 (53.4\%) had cellulitis, and 82 (15.6\%) had mixed infection, defined as at least one abscess lesion and one cellulitis lesion. S. aureus was isolated from the lesions of 217 patients (41.4\%); the isolates in 167 (77.0\%) of these patients were MRSA. The proportion of patients cured was similar in the two treatment groups in the intention-to-treat population (80.3\% in the clindamycin group and 77.7\% in the TMP-SMX group; difference, −2.6 percentage points; 95\% confidence interval [CI], −10.2 to 4.9; P = 0.52) and in the populations of patients who could be evaluated (466 patients; 89.5\% in the clindamycin group and 88.2\% in the TMP-SMX group; difference, −1.2 percentage points; 95\% CI, −7.6 to 5.1; P = 0.77). 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. From the Los Angeles Biomedical Research Institute (L.G.M., S.J.E.) and Division of Infectious Diseases, Harbor–UCLA (University of California, Los Angeles) Medical Center (L.G.M., S.J.E.), Torrance, David Geffen School of Medicine at UCLA, Los Angeles (L.G.M., S.J.E.), Division of Plastic and Reconstructive Surgery, University of California, San Francisco (UCSF) (D.Y.), and Division of Infectious Diseases, San Francisco General Hospital and UCSF (M.D.D., H.F.C.), San Francisco —all in California; Division of Pediatric Infectious Diseases, University of Chicago, Chicago (R.S.D.); Division of Pediatric Infectious Diseases, Vanderbilt University, Nashville (C.B.C.); the EMMES Corporation, Rockville, MD (S.P.); and Cota Enterprises, Meriden, KS (R.J.H.). Address reprint requests to Dr. Miller at the Division of Infectious Diseases, Harbor–UCLA Medical Center, 1000 W. Carson St., Box 466, Torrance, CA 90509, or at l­gmiller@ ­ucla.­edu. *A list of additional members of the Division of Microbiology and Infectious Diseases (DMID) 07-0051 Team is provided in the Supplementary Appendix, available at NEJM.org. N Engl J Med 2015;372:1093-103. DOI: 10.1056/NEJMoa1403789 Copyright © 2015 Massachusetts Medical Society.
CONCLUSIONS 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. (Funded by the National Institute of Allergy and Infectious Diseases and the National Center for Advancing Translational Sciences, National Institutes of Health; ClinicalTrials.gov number, NCT00730028.)},
	language = {en},
	number = {12},
	urldate = {2019-08-05},
	journal = {New England Journal of Medicine},
	author = {Miller, Loren G. and Daum, Robert S. and Creech, C. Buddy and Young, David and Downing, Michele D. and Eells, Samantha J. and Pettibone, Stephanie and Hoagland, Rebecca J. and Chambers, Henry F.},
	month = mar,
	year = {2015},
	note = {00000},
	pages = {1093--1103}
}
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