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Authors
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Faculty in Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Professor of Medicine in Residence at Olive View Medical CenterDavid Talan, MD
Faculty in Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Professor of Medicine in Residence at Olive View Medical CenterFaculty in Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Professor of Medicine in Residence at Olive View Medical Center
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Chief, Department of Emergency Medicine and Faculty, Division of Infectious Diseases, Professor of Clinical Medicine at Olive View Medical CenterGregory Moran, MD
Chief, Department of Emergency Medicine and Faculty, Division of Infectious Diseases, Professor of Clinical Medicine at Olive View Medical CenterChief, Department of Emergency Medicine and Faculty, Division of Infectious Diseases, Professor of Clinical Medicine at Olive View Medical Center
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Experts
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Director of Research at Brigham and Women's Hospital, Department of Emergency MedicineDaniel Jay Pallin, MD, MPH
Director of Research at Brigham and Women's Hospital, Department of Emergency MedicineDirector of Research at Brigham and Women's Hospital, Department of Emergency Medicine
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Director of Emergency Department Antibiotic Stewardship, Associate Professor of Emergency Medicine at UC Davis Health SystemLarissa May, MD, MSPH, MSHS
Director of Emergency Department Antibiotic Stewardship, Associate Professor of Emergency Medicine at UC Davis Health SystemDirector of Emergency Department Antibiotic Stewardship, Associate Professor of Emergency Medicine at UC Davis Health System
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Professor of Pediatrics, Microbiology, Molecular Medicine at University of ChicagoRobert Daum, MD, CM
Professor of Pediatrics, Microbiology, Molecular Medicine at University of ChicagoProfessor of Pediatrics, Microbiology, Molecular Medicine at University of Chicago
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Assistant Professor of Internal Medicine at University of Utah School of MedicinePeter Yarbrough, MD
Assistant Professor of Internal Medicine at University of Utah School of MedicineAssistant Professor of Internal Medicine at University of Utah School of Medicine
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Professor of Plastic Surgery at University of California, San FranciscoDavid Young, MD
Professor of Plastic Surgery at University of California, San FranciscoProfessor of Plastic Surgery at University of California, San Francisco
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Chief of Infectious Diseases Section, Director of Research and Development of the Veterans Affairs Medical Center in Boise, Idaho, Professor of Medicine at University of Washington School of MedicineDennis Stevens, MD, PhD
Chief of Infectious Diseases Section, Director of Research and Development of the Veterans Affairs Medical Center in Boise, Idaho, Professor of Medicine at University of Washington School of MedicineChief of Infectious Diseases Section, Director of Research and Development of the Veterans Affairs Medical Center in Boise, Idaho, Professor of Medicine at University of Washington School of Medicine
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Associate Professor of Emergency Medicine at University of Texas Health Science Center at San AntonioGillian Schmitz, MD
Associate Professor of Emergency Medicine at University of Texas Health Science Center at San AntonioAssociate Professor of Emergency Medicine at University of Texas Health Science Center at San Antonio
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Associate Professor of Medicine at CEMICMartin Stryjewski, MD, MHS
Associate Professor of Medicine at CEMICAssociate Professor of Medicine at CEMIC
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Assistant Professor of Pediatrics and Emergency Medicine at University of PittsburghJennifer Marin, MD, MSc
Assistant Professor of Pediatrics and Emergency Medicine at University of PittsburghAssistant Professor of Pediatrics and Emergency Medicine at University of Pittsburgh
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Medical Epidemiologist, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infections Diseases at Centers for Disease Control and PreventionLauri Hicks, DO
Medical Epidemiologist, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infections Diseases at Centers for Disease Control and PreventionMedical Epidemiologist, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infections Diseases at Centers for Disease Control and Prevention
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Associate Professor of Medicine at CEMICMartin Stryjewski, MD., MHS.
Associate Professor of Medicine at CEMICAssociate Professor of Medicine at CEMIC
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Lead Moderators
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Medical Student at Harvard Medical SchoolEdward Grom
Medical Student at Harvard Medical SchoolMedical Student at Harvard Medical School
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Moderators
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MedEd Fellow, EM Physician at University of WashingtonLaura Welsh, MD
MedEd Fellow, EM Physician at University of WashingtonMedEd Fellow, EM Physician at University of Washington
About the Discussion
@NEJM Ask the Authors & Experts: Trimethoprim-Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess
ORIGINAL ARTICLE
Trimethoprim-Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess
David A. Talan, M.D., William R. Mower, M.D., Ph.D., Anusha Krishnadasan, Ph.D., Fredrick M. Abrahamian, D.O., Frank Lovecchio, D.O., David J. Karras, M,D., Mark T. Steele, M.D., Richard E. Rothman, M.D., Ph.D., Rebecca Hoagland, M.S., Gregory J. Moran, M.D.
N Engl J Med 2016; 374: 823-32| March 2, 2016 | DOI: 10.1056/NEJMoa1507476
BACKGROUND
U.S. emergency department visits for cutaneous abscess have increased with the emergence of methicillin-resistant Staphylococcus aureus (MRSA). The role of antibiotics for patients with a drained abscess is unclear.
METHODS
We conducted a randomized trial at five U.S. emergency departments to determine whether seven-days of trimethoprim-sulfamethoxazole (320mg/1600mg twice daily) is superior to placebo for outpatients age >12 years with an uncomplicated abscess receiving drainage. The primary outcome was clinical cure of the abscess assessed 7-14 days after treatment.
RESULTS
Subjects were median age 35 years (range, 14-73); 45.3% of abscesses grew MRSA. In the modified intention-to-treat population, clinical cure of the abscess occurred in 507 of 630 (80.5%) trimethoprim-sulfamethoxazole treated versus 454 of 617 (73.6%) placebo treated subjects (difference 6.9 percentage points; 95% CI 2.1%, 11.7%, p=0.0046). In the per-protocol population, the trimethoprim-sulfamethoxazole group had improved secondary outcomes compared to the placebo group including fewer subsequent surgical drainage procedures (3.4% vs. 8.6%; difference -5.2 percentage points; 95% CI -8.2%, -2.2%), new site skin infections (3.1% vs. 10.3%; difference -7.2 percentage points, 95% CI -10.4%, -4.1%), and infections in household members (1.7% vs. 4.1%, difference -2.4 percentage points, 95% CI -4.6%, -0.2%) 7-14 days after treatment. Trimethoprim-sulfamethoxazole was associated with slightly more, mostly mild, gastrointestinal side effects. Through 7-14 days after treatment, invasive infections developed in 2 (0.4%) trimethoprim-sulfamethoxazole-treated subjects and 2 (0.4%) placebo-treated subjects, and through 42-56 days after treatment, in one (0.2%) trimethoprim sulfamethoxazole-treated subject.
CONCLUSIONS
In settings where MRSA was prevalent, trimethoprim-sulfamethoxazole treatment produced higher abscess cure rates than placebo. (ClinicalTrials.gov number, NCT00729937).
Originally Appeared in The New England Journal of Medicine on March 2, 2016.
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Authors
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Faculty in Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Professor of Medicine in Residence at Olive View Medical CenterDavid Talan, MD
Faculty in Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Professor of Medicine in Residence at Olive View Medical Center
Faculty in Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Professor of Medicine in Residence at Olive View Medical Center
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Chief, Department of Emergency Medicine and Faculty, Division of Infectious Diseases, Professor of Clinical Medicine at Olive View Medical CenterGregory Moran, MD
Chief, Department of Emergency Medicine and Faculty, Division of Infectious Diseases, Professor of Clinical Medicine at Olive View Medical Center
Chief, Department of Emergency Medicine and Faculty, Division of Infectious Diseases, Professor of Clinical Medicine at Olive View Medical Center
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Experts
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Director of Research at Brigham and Women's Hospital, Department of Emergency MedicineDaniel Jay Pallin, MD, MPH
Director of Research at Brigham and Women's Hospital, Department of Emergency Medicine
Director of Research at Brigham and Women's Hospital, Department of Emergency Medicine
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Director of Emergency Department Antibiotic Stewardship, Associate Professor of Emergency Medicine at UC Davis Health SystemLarissa May, MD, MSPH, MSHS
Director of Emergency Department Antibiotic Stewardship, Associate Professor of Emergency Medicine at UC Davis Health System
Director of Emergency Department Antibiotic Stewardship, Associate Professor of Emergency Medicine at UC Davis Health System
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Professor of Pediatrics, Microbiology, Molecular Medicine at University of ChicagoRobert Daum, MD, CM
Professor of Pediatrics, Microbiology, Molecular Medicine at University of Chicago
Professor of Pediatrics, Microbiology, Molecular Medicine at University of Chicago
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Assistant Professor of Internal Medicine at University of Utah School of MedicinePeter Yarbrough, MD
Assistant Professor of Internal Medicine at University of Utah School of Medicine
Assistant Professor of Internal Medicine at University of Utah School of Medicine
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Professor of Plastic Surgery at University of California, San FranciscoDavid Young, MD
Professor of Plastic Surgery at University of California, San Francisco
Professor of Plastic Surgery at University of California, San Francisco
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Chief of Infectious Diseases Section, Director of Research and Development of the Veterans Affairs Medical Center in Boise, Idaho, Professor of Medicine at University of Washington School of MedicineDennis Stevens, MD, PhD
Chief of Infectious Diseases Section, Director of Research and Development of the Veterans Affairs Medical Center in Boise, Idaho, Professor of Medicine at University of Washington School of Medicine
Chief of Infectious Diseases Section, Director of Research and Development of the Veterans Affairs Medical Center in Boise, Idaho, Professor of Medicine at University of Washington School of Medicine
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Associate Professor of Emergency Medicine at University of Texas Health Science Center at San AntonioGillian Schmitz, MD
Associate Professor of Emergency Medicine at University of Texas Health Science Center at San Antonio
Associate Professor of Emergency Medicine at University of Texas Health Science Center at San Antonio
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Associate Professor of Medicine at CEMICMartin Stryjewski, MD, MHS
Associate Professor of Medicine at CEMIC
Associate Professor of Medicine at CEMIC
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Assistant Professor of Pediatrics and Emergency Medicine at University of PittsburghJennifer Marin, MD, MSc
Assistant Professor of Pediatrics and Emergency Medicine at University of Pittsburgh
Assistant Professor of Pediatrics and Emergency Medicine at University of Pittsburgh
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Medical Epidemiologist, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infections Diseases at Centers for Disease Control and PreventionLauri Hicks, DO
Medical Epidemiologist, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infections Diseases at Centers for Disease Control and Prevention
Medical Epidemiologist, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infections Diseases at Centers for Disease Control and Prevention
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Associate Professor of Medicine at CEMICMartin Stryjewski, MD., MHS.
Associate Professor of Medicine at CEMIC
Associate Professor of Medicine at CEMIC
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Lead Moderators
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Medical Student at Harvard Medical SchoolEdward Grom
Medical Student at Harvard Medical School
Medical Student at Harvard Medical School
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Moderators
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MedEd Fellow, EM Physician at University of WashingtonLaura Welsh, MD
MedEd Fellow, EM Physician at University of Washington
MedEd Fellow, EM Physician at University of Washington
