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Knowing clindamycin susceptibilities is key to treating MRSA

AAP 2011 National Conference

BOSTON — In hospitalized children with complicated skin and soft-tissue infections, vancomycin remains the gold standard, according to recently published guidelines by the Infectious Diseases Society of America (IDSA).

Sheldon Kaplan, MD, an Infectious Diseases in Children Editorial Board member who also helped author the IDSA guidelines, discussed the guidelines today during the American Academy of Pediatrics 2011 National Conference and Exhibition held here.

Kaplan noted that for skin and soft-tissue infections (SSTI), incision and drainage are the recommended primary treatment. He said the guidelines recommend antibiotics only for those in “extremes of age,” and he recommended those children younger than 12 months of age should probably get antibiotics, because there are data to suggest antibiotics may decrease recurrent infections. He also cited data that suggested recurrences were less in one study with clindamycin when compared with trimethoprim-sulfamethoxazole.

However, Kaplan said, “if you are going to use clindamycin, you have to know what the clindamycin susceptibilities are in your area.” He noted levels of resistance at about 7% in Philadelphia, 9% in Baltimore, and as high as 22% in certain areas of Chicago.

Kaplan said there are studies ongoing that should help clarify the antibiotic issue in coming years.

For children with minor skin infections, such as impetigo, and secondarily infected skin lesions, such as eczema, mupirocin 2% topical ointment may be used, and in those situations where the impetigo may be more extensive, clindamycin may be considered, he said.

Kaplan emphasized the importance of educating parents of patients about proper wound care and personal and environmental hygiene.

Trough vancomycin concentrations should be used to guide dosing and achieve target concentrations in patients with serious MRSA infections, such as bacteremia, infective endocarditis, osteomyelitis, meningitis, pneumonia and severe skin and soft-tissue infections (eg, necrotizing fasciitis), according to Kaplan’s presentation.

The guidelines also discuss the management of patients with MRSA isolates with reduced susceptibility to vancomycin, vancomycin treatment failures and the use of alternatives to vancomycin therapy. – by Colleen Zacharyczuk

Disclosure: Dr. Kaplan reports receiving grant funding from Pfizer.

For more information:

• Kaplan S. # X1004. Community-associated MRSA. Presented at: AAP 2011 National Conference and Exhibition; Oct. 15-18, 2011; Boston.
• Liu C. Clin Infect Dis. 2011;53:285-322.

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