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 B Williams, Kermit Huebner, Jeffrey Lightfoot, Brandon Ritz, Christopher Bates, Matthew Schmitz, Mihriye Mete, Gregory Deye

Research output: Contribution to journalArticlepeer-review

119 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 2010

ASJC Scopus subject areas

  • Emergency Medicine

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