A Randomized Trial of Clindamycin versus Trimethoprim-Sulfamethoxazole for Uncomplicated Wound Infection.
Clin Infect Dis. 2016 Mar 29;
Authors: Talan DA, Lovecchio F, Abrahamian FM, Karras DJ, Steele MT, Rothman RE, Krishnadasan A, Mower WR, Hoagland R, Moran GJ
BACKGROUND: With the emergence of community-associated methicillin-resistantStaphylococcus aureus(MRSA) in the U.S., visits for skin infections greatly increased. Staphylococci and streptococci are considered predominant causes of wound infections. Clindamycin and trimethoprim-sulfamethoxazole are commonly prescribed, but trimethoprim-sulfamethoxazole's efficacy has been questioned.
METHODS: We conducted a randomized, double-blind, superiority trial at five U.S. emergency departments. Patients >12 years of age with an uncomplicated wound infection received oral clindamycin 300 mg four times daily or trimethoprim-sulfamethoxazole 320 mg/1600 mg twice daily, each for seven days. We compared the primary outcome, wound infection cure at 7-14 days, and secondary outcomes through 6-8 weeks after treatment, in the per-protocol population.
RESULTS: Subjects were median age 40 years (range, 14-76); 40.1% of wound specimens grew MRSA, 25.7% methicillin-susceptibleS. aureus, and 5.0% streptococci. The wound infection was cured at 7-14 days in 187 of 203 (92.1%) clindamycin-treated and 182 of 198 (91.9%) trimethoprim-sulfamethoxazole-treated subjects (difference 0.2%; 95% CI -5.8%, 6.2%; p=NS). The clindamycin group had a significantly lower rate of recurrence at 7-14 days (1.5 vs. 6.6%; difference -5.1%; 95% CI, -9.4%, -0.8%) and through 6-8 weeks following treatment (2.0 vs. 7.1%; difference -5.1%; 95% CI -9.7%, -0.6%). Other secondary outcomes were statistically similar between groups but tended to favor clindamycin. Adverse event rates were similar.
CONCLUSIONS: In settings where MRSA is prevalent, clindamycin and trimethoprim-sulfamethoxazole produce similar cure and adverse event rates among patients with an uncomplicated wound infection. Further study evaluating differential effects of antibiotics on recurrent infection may be warranted.
PMID: 27025829 [PubMed - as supplied by publisher]