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Clindamycin may be superior therapy for skin, soft tissue infections

NEW YORK — Clindamycin may be a more effective treatment for skin and soft tissue infections in children compared with trimethoprim-sulfamethoxazole, according to data presented at the 2014 Infectious Diseases in Children Symposium.

To address how purulent skin and soft tissue infections (SSTIs) should be managed and treated, C. Buddy Creech, MD, MPH, an Infectious Diseases in Children Editorial Board member, reviewed data from several recently published studies.

C. Buddy Creech

A retrospective study published in Pediatrics in 2011 and conducted by Derek J. Williams, MD, MPH, and colleagues, examined a cohort of 41,094 patients aged 0 to 17 years diagnosed with an SSTI who received antibiotics. Researchers observed that 6,407 children who underwent drainage and received systemic antimicrobial therapy. Of these, 9% experienced treatment failure, and 23% had infection recurrences.

According to Creech, odds of treatment failure were significantly greater among patients who received trimethoprim-sulfamethoxazole (TMP-SMX) compared with clindamycin. Further, incidence of recurrence within 1 year was greater among those who received TMP-SMX vs. those treated with clindamycin. These correlations remained after adjusting for potential confounders and interactions between covariates.

A prospective, randomized, placebo-controlled study explored clindamycin vs. TMP-SMX in 155 children and 369 adults with abscesses that measured 5 cm or larger or cellulitis. The study found no difference in cure rates when comparing clindamycin and TMP-SMX; however, when assessed 1 month after treatment, children assigned TMP-SMX were slightly more likely to have recurrences.

“One interesting part of this study is that 94% of those who received clindamycin and 95% of those who received TMP-SMX, who were 100% compliant based on pill counts, experienced a clinical cure. But if you look at those who were less than 75% compliant, those numbers are 56% and 41%,” Creech said during the presentation.

These data suggest that drugs with difficult tolerability, such as clindamycin, may affect cure rates.

Results from a large randomized trial comparing bleach baths alone vs. bleach baths plus routine hygiene indicated bleach baths alone are not effective. Results were similar when only children with S. aureus were analyzed.

Additionally, household approaches to eradication of community-associated S. aureus appeared to be more effective than individual approaches, according to Creech, who cited study findings from Stephanie A. Fritz, MD, MSCI, and colleagues.

Thus, the goal of eradication, according to Creech, is not to eradicate carriage forever, but to eradicate the specific strain of S. aureus plaguing the patient and their household.

“To conclude, the initial treatment of abscesses should be to drain them if you can. For abscesses larger than 5 cm, clindamycin and TMP-SMX appear to be equally effective in the prospective study while clindamycin had a bit of an edge in the retrospective study,” Creech said. “For prevention of recurrence, based on these new data that have emerged, recurrence risk can be reduced based on the initial therapy and on the decolonization strategies that you choose.”

For more information:

Creech CB. “Update on Staphylococcal Disease in Children.” Presented at: IDC NY 2014; Nov. 22-23; New York.

Disclosure: Creech reports financial ties with Pfizer, Novartis Vaccines and Vidara Therapeutics.