Antibiotics After Incision and Drainage Effective for Uncomplicated Skin Infections

Clindamycin or TMP-SMX following I&D was more effective at curing Staphylococcus aureus infection in children and adults compared with placebo.

NEW ORLEANS – In conjunction with incision and drainage, clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX) exceeded cure rates in children and adults with small, uncomplicated skin abscesses compared to placebo, according to a study presented at IDWeek 2016.

Robert S. Daum, MD, professor of pediatrics at the University of Chicago Medicine in Chicago, Illinois, and colleagues conducted a multicenter, prospective, placebo-controlled, double-blind study in which outpatient children and adults with uncomplicated skin abscesses were randomly assigned to receive clindamycin (n=266), TMP-SMX (n=263), or placebo (n=257) for 10 days. 

A total of 786 patients were enrolled in the study; 64.2% (505) adults and 35.8% (281) children. Skin abscesses had a maximum diameter of 5 cm for adults, a maximum diameter of 3 cm for infants aged 3 to 11 months, and a maximum diameter of 4 cm for children aged 1 to 8 years. Staphylococcus aureus was isolated from 67% of patients and methicillin-resistant S aureus (MRSA) from 49.4% of patients.

“At the 10-day, post-therapy, test-of-cure visit, in the intention-to-treat population, mean cure rates among subjects receiving clindamycin or TMP-SMX were similar to each other but each was greater than placebo (P =.0001 and P =.0008, respectively),” Dr Daum and colleagues noted.

In patients with a clindamycin-resistant S aureus isolate, the cure rate was 53.8% compared with 85.3% in the clindamycin-susceptible isolate group.

No cases of Clostridium difficile-associated diarrhea were observed.  While adverse events occurred more frequently in the clindamycin group (21.9%) compared with those receiving TMP-SMX (11.1%) and placebo (12.5%), fewer new skin infections occurred in the clindamycin group at the one-month follow-up visit after initial cure.

The researchers concluded that “clindamycin or TMP-SMX, in conjunction with incision and drainage, improves outcomes of subjects with a small abscess compared with incision and drainage alone in both children and adults.”

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Daum RS, Miller L, Immergluck L, et al. Clindamycin versus trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin and soft tissue abscesses. Presented at: IDWeek 2016. New Orleans, LA; October 26-30, 2016. Abstract 1684.