This article is more than 5 years old. Information may no longer be current.
Clindamycin, TMP-SMX comparably effective, safe for uncomplicated skin infections
Click Here to Manage Email Alerts
Results from a multicenter, prospective, randomized double blind clinical trial indicate clindamycin and trimethoprim-sulfamethoxazole have comparable efficacy and safety for treatment of uncomplicated skin infections.
"Results of cultures of skin-infection lesions in the United States have shown that most of the infections are caused by methicillin-resistant Staphylococcus aureus (MRSA)," study researcher Loren G. Miller, MD, MPH, of the Los Angeles Biomedical Research Institute, and colleagues wrote. "Either clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) is recommended [for treatment of these infections] because of the low cost and activity against community-associated MRSA and methicillin-susceptible S. aureus (MSSA) strains of each of these drugs, yet there are few comparative data on the safety and efficacy of these antibiotic agents for the treatment of skin infections."
Loren G. Miller
Patients were recruited from four locations from May 2009 through August 2011 and were eligible for study inclusion if they experienced two or more of the following symptoms for at least 24 hours: erythema, swelling or induration, local warmth, purulent drainage and tenderness to pain or palpation. Study participants were categorized to have cellulitis, abscess or both and were randomly assigned clindamycin (n = 264) or TMP-SMX (n = 260). The mean age of the participants was 27.1 years; children accounted for 29.6% of the cohort. Patients were assessed at the end of treatment, 7 to 10 days after treatment completion and 30 days after treatment completion.
Clindamycin was administered as two 150-mg tablets three times daily. TMP-SMX was administered as 160 mg trimethoprim and 800 mg sulfamethoxazole in two single-strength tablets twice daily. Both were 10-day interventions. Pediatric doses were adjusted according to body weight.
Fifty-three percent of the study cohort had cellulitis, 30.5% had abscess, and 15.6% had abscess and cellulitis.
Culture results were available for 56.5% of the cohort; the most common isolate found at baseline was S. aureus (41.4%).
Seven to 10 days after treatment, which was considered the test-of-cure visit, patients who received clindamycin had an 80.3% rate of cure (95% CI, 75.2-85.4) vs. 77.7% (95% CI, 72.3-83.1) among patients who received TMP-SMX.
At 1-month follow-up, cure rates were 73.1% (95% CI, -67.6 to 78.6) among patients who received clindamycin vs. 67.7% (95% CI, 61.8-73.6) among those who received TMP-SMX.
Adverse event rates were similar between treatment groups overall: 18.9% among the clindamycin group and 18.6% among the TMP-SMX group. Diarrhea, nausea and vomiting were the most common adverse events.
"This well-powered superiority trial did not show the superiority of either intervention. Although it is not appropriate to claim that there are no differences on the basis of negative result of the superiority test, important differences can reasonably be ruled out with the use of confidence intervals. Adverse-event rates with the two therapies were similar," Miller and colleagues concluded.
Disclosure: Miller reports receiving consulting fees with Cubist, Durata and Pfizer. Please see the full study for a list of all other authors' relevant financial disclosures.
Click Here to Manage Email Alerts