Randomized Controlled Trial of Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Abscesses in Patients at Risk for Community-Associated Methicillin-Resistant Staphylococcus aureus Infection

• Published in: Annals of emergency medicine 2010-09, Vol.56 (3), p.283-287
• Main Authors: Schmitz, Gillian R., MD, Bruner, David, MD, Pitotti, Rebecca, RN, BSN, Olderog, Cameron, MD, Livengood, Timothy, MD, Williams, Justin, MD, Huebner, Kermit, MD, Lightfoot, Jeffrey, MD, Ritz, Brandon, MD, Bates, Christopher, MD, Schmitz, Matthew, MD, Mete, Mihriye, PhD, Deye, Gregory, MD
• Format: Article
• Language: English
• Subjects: Abscess - drug therapy; Abscess - microbiology; Abscesses; Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Infective Agents - therapeutic use; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Double-Blind Method; Drainage; Emergency; Female; Humans; Intensive care medicine; Male; Medical sciences; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Risk Factors; Staphylococcal Skin Infections - drug therapy; Staphylococcal Skin Infections - microbiology; Staphylococcus aureus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Young Adult
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2010.03.002

Study objective Community-associated methicillin-resistant Staphylococcus aureus is now the leading cause of uncomplicated skin abscesses in the United States, and the role of antibiotics is controversial. We evaluate whether trimethoprim-sulfamethoxazole reduces the rate of treatment failures during the 7 days after incision and drainage and whether it reduces new lesion formation within 30 days. Methods In this multicenter, double-blind, randomized, placebo-controlled trial, we randomized adults to oral trimethoprim-sulfamethoxazole or placebo after uncomplicated abscess incision and drainage. Using emergency department rechecks at 2 and 7 days and telephone follow-up, we assessed treatment failure within 7 days, and using clinical follow-up, telephone follow-up, and medical record review, we recorded the development of new lesions within 30 days. Results We randomized 212 patients, and 190 (90%) were available for 7-day follow-up. We observed a statistically similar incidence of treatment failure in patients receiving trimethoprim-sulfamethoxazole (15/88; 17%) versus placebo (27/102; 26%), difference 9%, 95% confidence interval –2% to 21%; P =.12. On 30-day follow-up (successful in 69% of patients), we observed fewer new lesions in the antibiotic (4/46; 9%) versus placebo (14/50; 28%) groups, difference 19%, 95% confidence interval 4% to 34%, P =.02. Conclusion After the incision and drainage of uncomplicated abscesses in adults, treatment with trimethoprim-sulfamethoxazole does not reduce treatment failure but may decrease the formation of subsequent lesions.