Randomized controlled trial of trimethoprim-sulfamethoxazole for uncomplicated skin abscesses in patients at risk for community-associated methicillin-resistant Staphylococcus aureus infection

Gillian R. Schmitz, David Bruner, Rebecca Pitotti, Cameron Olderog, Timothy Livengood, Justin Williams, Kermit Huebner, Jeffrey Lightfoot, Brandon Ritz, Christopher Bates, Matthew Schmitz, Mihriye Mete, Gregory Deye

Research output: Contribution to journalArticlepeer-review

111 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)283-287
Number of pages5
JournalAnnals of Emergency Medicine
Volume56
Issue number3
DOIs
StatePublished - Sep 1 2010

ASJC Scopus subject areas

  • Emergency Medicine

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