Randomized controlled trial of cephalexin versus clindamycin for uncomplicated pediatric skin infections

Aaron E. Chen, Karen C. Carroll, Marie Diener-West, Tracy Ross, Joyce Ordun, Mitchell A. Goldstein, Gaurav Kulkarni, J. B. Cantey, George K. Siberry

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

OBJECTIVE: To compare clindamycin and cephalexin for treatment of uncomplicated skin and soft tissue infections (SSTIs) caused predominantly by community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA). We hypothesized that clindamycin would be superior to cephalexin (an antibiotic without MRSA activity) for treatment of these infections. PATIENTS AND METHODS: Patients aged 6 months to 18 years with uncomplicated SSTIs not requiring hospitalization were enrolled September 2006 through May 2009. Eligible patients were randomly assigned to 7 days of cephalexin or clindamycin; primary and secondary outcomes were clinical improvement at 48 to 72 hours and resolution at 7 days. Cultures were obtained and tested for antimicrobial susceptibilities, pulsed-field gel electrophoresis type, and Panton-Valentine leukocidin status. RESULTS: Of 200 enrolled patients, 69% had MRSA cultured from wounds. Most MRSA were USA300 or subtypes, positive for Panton-Valentine leukocidin, and clindamycin susceptible, consistent with CAMRSA. Spontaneous drainage occurred or a drainage procedure was performed in 97% of subjects. By 48 to 72 hours, 94% of subjects in the cephalexin arm and 97% in the clindamycin arm were improved (P = .50). By 7 days, all subjects were improved, with complete resolution in 97% in the cephalexin arm and 94% in the clindamycin arm (P = .33). Fevers and age less than 1 year, but not initial erythema > 5 cm, were associated with early treatment failures, regardless of antibiotic used. CONCLUSIONS: There is no significant difference between cephalexin and clindamycin for treatment of uncomplicated pediatric SSTIs caused predominantly by CA-MRSA. Close follow-up and fastidious wound care of appropriately drained, uncomplicated SSTIs are likely more important than initial antibiotic choice.

Original languageEnglish (US)
Pages (from-to)e573-e580
JournalPediatrics
Volume127
Issue number3
DOIs
StatePublished - Mar 2011
Externally publishedYes

Keywords

  • Abscess
  • Cephalexin
  • Clindamycin
  • MRSA
  • Skin infections
  • Staphylococcus aureus

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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