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Thorough cleaning of pediatric skin infections more important than antibiotic choice

Chen AE. Pediatrics. 2011;127:e573-e580.

Vigilance and fastidious wound care of drained, uncomplicated pediatric skin and soft tissue infections likely have more effect than choice of antibiotic treatment, researchers have found.

In a randomized controlled trial comparing cephalexin and clindamycin for treatment of uncomplicated pediatric skin and soft tissue infections, 200 patients aged 6 months to 18 years with uncomplicated skin or soft tissue infections were enrolled from September 2006 to May 2009. One hundred patients in each arm were randomly assigned to 7 days of treatment with cephalexin or clindamycin. Primary and secondary outcomes were clinical improvement of wounds at 48 to 72 hours and resolution of wounds at 7 days.

More than two-thirds (69%) of all patients had methicillin-resistant Staphylococcus aureus cultured from their wounds. Most MRSA were clindamycin-susceptible, consistent with community-associated MRSA. Spontaneous drainage occurred or incision and drainage was performed in 97% of patients. By 48 to 72 hours, 94% of patients in the cephalexin arm and 97% in the clindamycin arm experienced improvement (P=.50). By 7 days, all patients’ wounds had improved, with 97% in the cephalexin group experiencing complete resolution and 94% in the clindamycin arm (P=.33).

Researchers found no association between gender, size of erythema or induration, location of infection, or type of drainage with the primary outcome. Fever and age of younger than 1 year, but not with initial erythema of more than 5 cm, were considered early-treatment failures, regardless of antibiotic used.

“Until additional studies confirm that adjuvant antibiotics offer no benefit in the management of children with uncomplicated, purulent [skin and soft tissue infections], cephalexin remains a viable empiric antibiotic choice (even in areas with a high prevalence of CA-MRSA) in the context of management that already includes careful drainage of purulent collections, attention to wound care, and appropriate follow-up, especially in children of younger age and with fever,” researchers wrote.

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