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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 Center
Chief, Department of Emergency Medicine and Faculty, Division of Infectious Diseases, Professor of Clinical Medicine at Olive View Medical Center
Director of Research at Brigham and Women's Hospital, Department of Emergency Medicine
Director of Emergency Department Antibiotic Stewardship, Associate Professor of Emergency Medicine at UC Davis Health System
Professor of Pediatrics, Microbiology, Molecular Medicine at University of Chicago
Assistant Professor of Internal Medicine at University of Utah School of Medicine
Professor of Plastic Surgery at University of California, San Francisco
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
Associate Professor of Emergency Medicine at University of Texas Health Science Center at San Antonio
Associate Professor of Medicine at CEMIC
Assistant Professor of Pediatrics and Emergency Medicine at University of Pittsburgh
Medical Epidemiologist, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infections Diseases at Centers for Disease Control and Prevention
Associate Professor of Medicine at CEMIC
Medical Student at Harvard Medical School
MedEd Fellow, EM Physician at University of Washington
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.
Faculty in Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Professor of Medicine in Residence 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
Director of Research at Brigham and Women's Hospital, Department of Emergency Medicine
Director of Emergency Department Antibiotic Stewardship, Associate Professor of Emergency Medicine at UC Davis Health System
Professor of Pediatrics, Microbiology, Molecular Medicine at University of Chicago
Assistant Professor of Internal Medicine at University of Utah School of Medicine
Professor of Plastic Surgery at University of California, San Francisco
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
Associate Professor of Emergency Medicine at University of Texas Health Science Center at San Antonio
Associate Professor of Medicine at CEMIC
Assistant Professor of Pediatrics and Emergency Medicine at University of Pittsburgh
Medical Epidemiologist, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infections Diseases at Centers for Disease Control and Prevention
Associate Professor of Medicine at CEMIC
Medical Student at Harvard Medical School
MedEd Fellow, EM Physician at University of Washington