TMP-SMX, clindamycin effective treatment of uncomplicated SSTIs

DENVER — Clindamycin and trimethoprim/sulfamethoxazole were similar in efficacy for primary treatment of uncomplicated skin and soft tissue infections, researchers reported during the 2013 Interscience Conference on Antimicrobial Agents and Chemotherapy.

“Clinicians should be encouraged that both clindamycin and TMP-SMX were effective in this trial of skin and soft tissue infections,” C. Buddy Creech, MD, MPH, of Vanderbilt University School of Medicine, said. “There has been concern that TMP-SMX is not as good as clindamycin; in this study, however, the likelihood of cure was not dependent upon choice of antibiotic.”

C. Buddy Creech, MD, MPH 

C. Buddy Creech

The study included 524 adults and children with uncomplicated skin and soft tissue infections (SSTIs). Participants were assigned to received either clindamycin (clindamycin; n=264) or trimethoprim/sulfamethoxazole (TMP-SMX; n=260).

Researchers found that 44% of participants had non-suppurative cellulitis. Staphylococcus aureus was found in 42% of participants, 82% of which was methicillin-resistant S. aureus. Of the S. aureusisolates, none were resistant to TMP-SMX compared with 14% to clindamycin.

In the intention-to-treat analysis, the cure rate for clindamycin was 80.3% (95% CI, 75.2-85.4) and 77.7% (95% CI, 72.3-83.1) for TMP-SMX (P=0.52). Adverse events were similar for each group.

“We found no differences in the efficacy of clindamycin and TMP-SMX in the primary treatment of uncomplicated SSTIs, specifically large or multiple suppurative infections and nonsuppurative cellulitis,” researchers wrote.

Loren G. Miller, MD, MPH 

Loren G. Miller

Loren G. Miller, MD, MPH, of the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues note that the similarity in efficacy of clindamycin and TMP-SMX for cases of nonsuppurative cellulitis suggests that TMP-SMX is similar in efficacy to clindamycin even for nonculturable skin infections likely to be caused by group A streptococcus. Overall, the researchers noted, “clinicians treating uncomplicated SSTIs of these types in the outpatient setting can choose either antibiotic without undue concern about clinical failure or intolerance.”

For more information:

Miller L. Abstract #L-337. Presented at: ICAAC 2013; Sept. 9-13, 2013; Denver.

Disclosure: See abstract for a full list of financial disclosures.

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