20 Mar Both Clindamycin and Trimethoprim–Sulfamethoxazole Effective For Uncomplicated Skin Infections
Medical Research: What is the background for this study?
Dr. Miller: Skin and skin structure infections are extremely common reasons for persons
to seek medical care in the U.S., accounting for approximately 14.2 million
outpatient visits in 2005, the latest year for which statistics are
available, and 850,000 hospital admissions. Until this study was completed,
the most effective approach to outpatient antibiotic treatment of
uncomplicated skin infections in the era of community-acquired
methicillin-resistant Staphylococcus aureus (MRSA) was unclear. Prior to
this research, there were no data on which antibiotics were best for
treatment of these common skin infections.
Medical Research: What are the main findings?
Dr. Miller: Two antibiotics frequently prescribed to treat serious skin infections –
clindamycin and trimethoprim sulfamethoxazole (TMP-SMX) – had similar rates
of success in curing uncomplicated infections in outpatients. They also had
similar rates of side effects.
To conduct the study, we recruited outpatients from emergency departments,
clinics and other healthcare facilities associated with Los Angeles County’s
Harbor-UCLA Medical Center, University of Chicago Medical Center, San
Francisco General Hospital and Vanderbilt University Medical Center from May
2009 to August 2011. We studied 524 adults and children with uncomplicated
skin infections who had cellulitis, abscesses of 5 centimeters or more or
both. In the multicenter, double blind, randomized clinical trial, 264
received clindamycin and 260 received TMP-SMX. We followed the outpatients
for a month after their treatment.
We found similar outcomes for both groups – 80.3% of the outpatients who
received clindamycin and 77.7% of the outpatients in the group that received
TMP-SMX were cured within seven to 10 days after the end of their treatment.
These are not considered significant differences, so our evaluation is that
these two commonly prescribed antibiotics for serious skin infections are
similarly effective in treating uncomplicated skin infections in children
and adults who have few or no major co-existing conditions.
Medical Research: What should clinicians and patients take away from your report?
Dr. Miller: In areas of where MRSA is a common cause of skin infections, which is all of
the United States and many parts of the world, either clindamycin or TMP-SMX
can be used to treat outpatients with uncomplicated skin infections,
regardless if the infection is cellulitis, abscess, or both.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Miller: Studies of other generic antibiotics for uncomplicated skin infections, such
as doxycycline, are warranted given some patients may not be able to take
these medications or local patterns of antimicrobial resistance may make
some of these therapies not useful.
Loren G. Miller, M.D., M.P.H., Robert S. Daum, M.D., C.M., C. Buddy Creech, M.D., M.P.H., David Young, M.D., Michele D. Downing, R.N., M.S.N., Samantha J. Eells, M.P.H., Stephanie Pettibone, B.S., Rebecca J. Hoagland, M.S., and Henry F. Chambers, M.D. for the DMID 07-0051 Team
MedicalResearch.com Interview with: Loren G. Miller, M.D., M.P.H. (2015). Both Clindamycin and Trimethoprim–Sulfamethoxazole Effective For Uncomplicated Skin Infections