scholarly journals Randomized, Double-Blind, Placebo-Controlled Trial of Cephalexin for Treatment of Uncomplicated Skin Abscesses in a Population at Risk for Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection

2007 ◽  
Vol 51 (11) ◽  
pp. 4044-4048 ◽  
Author(s):  
Priya M. Rajendran ◽  
David Young ◽  
Toby Maurer ◽  
Henry Chambers ◽  
Francoise Perdreau-Remington ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Confidence Interval ◽  
Clinical Cure ◽  
Controlled Trial ◽  
Beta Lactam ◽  
Cure Rate ◽  
Double Blind ◽  
Incision And Drainage ◽  
Methicillin Resistant

ABSTRACT Empirical use of beta-lactam antibiotics, the preferred agents for treating uncomplicated skin and soft tissue infections, may no longer be appropriate for these infections because of the increasing prevalence of community strains of methicillin-resistant Staphylococcus aureus (MRSA). Retrospective studies, however, suggest that outcomes are good even when beta-lactams are used. We conducted a randomized, double-blind trial of 166 outpatient subjects comparing placebo to cephalexin at 500 mg orally four times for 7 days after incision and drainage of skin and soft tissue abscesses. The primary outcome was clinical cure or failure 7 days after incision and drainage. S. aureus was isolated from 70.4% of abscess cultures. Of the isolates tested 87.8% were MRSA, 93% of which were positive for Panton-Valentine leucocidin genes. Clinical cure rates were 90.5% (95% confidence interval, 0.82 to 0.96) in the 84 placebo recipients and 84.1% (95% confidence interval, 0.74 to 0.91) in the 82 cephalexin recipients (difference in the two proportions, 0.0006; 95% confidence interval, −0.0461 to 0.0472; P = 0.25). The 90.5% cure rate observed in the placebo arm and 84.1% cure rate observed in the cephalexin arm provide strong evidence that antibiotics may be unnecessary after surgical drainage of uncomplicated skin and soft tissue abscesses caused by community strains of MRSA.

Intravenous cefazolin plus oral probenecid versus oral cephalexin for the treatment of skin and soft tissue infections: a double-blind, non-inferiority, randomised controlled trial

2018 ◽  
Vol 35 (8) ◽  
pp. 492-498 ◽  
Author(s):  
Dawn Dalen ◽  
Amy Fry ◽  
Samuel G Campbell ◽  
Jeffrey Eppler ◽  
Peter J Zed
Keyword(s):  
Soft Tissue ◽  
Clinical Cure ◽  
Controlled Trial ◽  
Tertiary Care ◽  
Risk Difference ◽  
Teaching Hospitals ◽  
Double Blind ◽  
Treatment Groups ◽  
Registration Number ◽  
Randomised Controlled

ObjectiveThe purpose of our study was to determine if cephalexin 500 mg orally four times daily was non-inferior to cefazolin 2 g intravenously daily plus probenecid 1 g orally daily in the management of patients with uncomplicated mild–moderate skin and soft tissue infection (SSTI) presenting to the ED.MethodsThis was a prospective, multicentre, double dummy-blind, randomised controlled non-inferiority trial conducted at two tertiary care teaching hospitals in Canada. Patients were enrolled if they presented to the ED with an uncomplicated SSTI, and randomly assigned in a 1:1 fashion to oral cephalexin or intravenous cefazolin plus oral probenecid for up to 7 days. The primary outcome was failure of therapy at 72 hours. Clinical cure at 7 days, intravenous to oral medication transition admission to hospital and adverse events were also evaluated.Results206 patients were randomised with 104 patients in the cephalexin group and 102 in the cefazolin and probenecid group. The proportion of patients failing therapy at 72 hours was similar between the treatment groups (4.2% and 6.1%, risk difference 1.9%, 95% CI −3.7% to 7.6%). Clinical cure at 7 days was not significantly different (100% and 97.7%, risk difference −2.3%, 95% CI −6.7% to 0.8%).ConclusionCephalexin at appropriate doses appears to be a safe and effective alternative to outpatient parenteral cefazolin in the treatment of uncomplicated mild–moderate SSTIs who present to the ED.Trial registration numberNCT01029782; Results.

scholarly journals Just the Facts: Methicillin-resistant Staphylococcus aureus and soft tissue abscess in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 149-151
Author(s):  
Heather Murray ◽  
Kirk Leifso
Keyword(s):  
Emergency Department ◽  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Incision And Drainage ◽  
Methicillin Resistant ◽  
Soft Tissue Abscess ◽  
Mrsa Strains ◽  
Almost All

Soft tissue abscess used to be an easy emergency department (ED) presentation: perform an incision and drainage (I + D) and discharge your patient. Times have changed. Methicillin-resistant Staphylococcus aureus (MRSA) is now a major cause of soft tissue abscess in ED patients. MRSA is, by definition, resistant to cloxacillin and cephalosporins. Almost all Canadian strains are susceptible to vancomycin and linezolid. MRSA strains are variably susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), tetra/doxycycline, and clindamycin, with pooled Canadian clindamycin resistance just over 40%.

Skin and Soft Tissue Infections

2020 ◽  
pp. 279-285
Author(s):  
Nicholas M. Orozco ◽  
Jessica Lange Osterman
Keyword(s):  
Staphylococcus Aureus ◽  
Pain Management ◽  
Soft Tissue ◽  
Soft Tissue Infections ◽  
Incision And Drainage ◽  
Methicillin Resistant ◽  
Streptococcus Species ◽  
Diagnostic Use ◽  
Follow Up Care

Skin and soft tissue infections (SSTIs) are a common presenting complaint to acute care centers. SSTIs include folliculitis, furuncle, carbuncle, impetigo, ecthyma, erysipelas, cellulitis, and abscess. These infections are caused by methicillin-resistant and methicillin-susceptible Staphylococcus aureus and streptococcus species. This chapter reviews nonpurulent and purulent SSTIs in pediatric patients; the bacterial etiology of these infections; clinical presentation and complications; antibiotic choice for treatment; and disposition of the patient, including when to obtain laboratory studies and decision to hospitalize. In addition, this chapter describes the diagnostic use of ultrasound for abscesses, pain management for incision and drainage of purulent infections, and follow-up care.

scholarly journals Randomized, Placebo-Controlled, Double-Blind Trial To Evaluate the Efficacy of Mupirocin for Eradicating Carriage of Methicillin-Resistant Staphylococcus aureus

1999 ◽  
Vol 43 (6) ◽  
pp. 1412-1416 ◽  
Author(s):  
Stephan Harbarth ◽  
Sasi Dharan ◽  
Nadia Liassine ◽  
Pascale Herrault ◽  
Raymond Auckenthaler ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Treatment Failure ◽  
Controlled Trial ◽  
Treatment Success ◽  
Skin Lesions ◽  
Subsequent Treatment ◽  
Double Blind ◽  
Methicillin Resistant ◽  
Mupirocin Resistance

ABSTRACT Mupirocin has been widely used for the clearance of nasal methicillin-resistant Staphylococcus aureus (MRSA) carriage during outbreaks, but no placebo-controlled trial has evaluated its value for eradicating MRSA carriage at multiple body sites in settings where MRSA is not epidemic. In a 1,500-bed teaching hospital with endemic MRSA, 102 patients colonized with MRSA were randomized into a double-blind, placebo-controlled trial and treated with either mupirocin (group M) or placebo (group P) applied to the anterior nares for 5 days; both groups used chlorhexidine soap for body washing. Follow-up screening, susceptibility testing, and genotyping were performed to evaluate treatment success, mupirocin or chlorhexidine resistance, and exogenous recolonization. At baseline, MRSA carriage was 60% in the nares, 38% in the groin, and 62% in other sites (skin lesions, urine). The MRSA eradication rate (all body sites) was 25% in group M (12 of 48 patients), compared to 18% in group P (9 of 50 patients; relative risk [RR], 0.72; 95% confidence interval [CI95], 0.33 to 1.55). At the end of follow-up, 44% of patients (19 of 43) were free of nasal MRSA in group M, compared to 23% (11 of 44) in group P (RR, 0.57; CI95, 0.31 to 1.04). Ten patients developed MRSA infections (three in group M and seven in group P). One mupirocin treatment failure was due to exogenous MRSA recolonization. No MRSA isolate showed chlorhexidine resistance or high-level mupirocin resistance; however, we observed an association (P = 0.003) between low-level mupirocin resistance at study entry (prevalence, 23%) and subsequent treatment failure in both study arms. These results suggest that nasal mupirocin is only marginally effective in the eradication of multisite MRSA carriage in a setting where MRSA is endemic.

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