1684. Clindamycin versus Trimethoprim-Sulfamethoxazole versus Placebo for Uncomplicated Skin and Soft Tissue Abscesses
Session: Oral Abstract Session: Studies that will Impact your Practice
Friday, October 28, 2016: 3:15 PM
Room: 275-277
Background: Small, uncomplicated skin abscesses are common in ambulatory settings. Yet the optimal treatment strategy in the era of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is unclear.

Methods: In a multicenter, prospective, placebo-controlled, double-blind study, we enrolled outpatient adults and children with uncomplicated skin abscesses less than or equal to 5 cm in diameter (less than or equal to 3 cm for ages 6 to 11 months and less than or equal to 4 cm for ages 1 to 8 years). Following abscess incision and drainage (I&D), subjects were randomized to clindamycin, trimethoprim-sulfamethoxazole (TMP-SMX), or placebo for ten days in a 1:1:1 ratio.

Results: We enrolled 786 subjects; 505 (64.2%) adults, 281 (35.8%) children, and 448 (57.0%) males. S. aureus was isolated from 527 subjects (67.0%) and MRSA was isolated from 388 (49.4%). At the 10-day, post-therapy, test of cure (TOC) visit, in the intention-to-treat population, mean cure rates among subjects receiving clindamycin (221/266, 83.1%) or TMP-SMX (215/263, 81.7%) were similar (p=0.73) and each was greater than placebo (177/257, 68.9%) (p=0.0001 and p=0.0008, respectively). Similar results were seen in the evaluable population. In clindamycin-treated subjects with a S. aureus lesion, seven of 13 subjects with a clindamycin-resistant isolate were cured (53.8%) compared with 145 of 170 subjects (85.3%) with a clindamycin-susceptible isolate. Adverse events were more frequent in the clindamycin group (58/265 21.9%) than the TMP-SMX (29/261, 11.1%) and placebo (32/255, 12.5%) groups; all resolved without sequelae. There was no Clostridium difficile-associated diarrhea. Among those initially cured, at the one-month follow-up visit, fewer new skin infections occurred among clindamycin recipients compared with those that received TMP-SMX or placebo.

Conclusion: Clindamycin or TMP-SMX, in conjunction with I&D, improves outcomes of subjects with a small abscess compared with I&D alone in both children and adults. The cure rates with either antibiotic exceeded placebo but were similar to each other. In subjects with a clindamycin-resistant S. aureus isolate, the cure rate was lower. Among subjects cured at the TOC visit, fewer new infections were noted at the one-month follow up visit.

Robert S Daum, MD, FIDSA, Pediatric Infectious Disease, University of Chicago, Chicago, IL, Loren Miller, MD, MPH, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, Lilly Immergluck, MD, MS, CRC, Morehouse School of Medicine, Atlanta, GA, Stephanie Fritz, MD, MSCI, Pediatric Infectious Diseases, Washington University School of Medicine in St. Louis, Saint Louis, MO, C. Buddy Creech, MD, MPH, FPIDS, Vanderbilt Vaccine Research Program and Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, David Young, MD, University of California, San Francisco, CA, Neha Kumar, M.D., Pediatrics, University of Chicago, Chicago, IL, Michele Downing, RN, MsN, University of California San Francisco, san francisco, CA, Stephanie Pettibone, BS, Emmes, rockville, MD, Rebecca Hoagland, MS, cota enterprises, meriden, KS, Samantha J. Eells, MPH, Division of Adult Infectious Diseases, Los Angeles Biomedical Research Institute At Harbor-UCLA Medical Center, Torrance, CA, Christine Chiou, MD, NIH, bethesda, MD and Henry Chambers, MD, FIDSA, Clinical Research Services, University of California San Francisco, Clinical and Translational Sciences Institute, San Francisco, CA

Disclosures:

R. S. Daum, None

L. Miller, None

L. Immergluck, None

S. Fritz, None

C. B. Creech, None

D. Young, None

N. Kumar, None

M. Downing, None

S. Pettibone, None

R. Hoagland, None

S. J. Eells, None

C. Chiou, None

H. Chambers, None

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