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In settings where community-acquired MRSA is prevalent, which antibiotic is best for uncomplicated wound infections?
New Study
- A new multicenter, randomized, double-blind trial in 500 patients compared 7 days of clindamycin 300 mg 4 times daily to trimethoprim-sulfamethoxazole (TMP-SMX) 4 single strength tablets twice daily.
- Follow-up was performed on days 3 4 (on therapy), 8 10 (end of therapy), 14 21 (test of cure), and 49 63 (extended-follow-up).
What They Found
- Clinical cure rate was > 90% in both groups in the per-protocol population (p = 0.91), and also similar in the intention to treat populations.
- Cultured bacteria were similar between the two groups:
- MRSA ~40%
- MSSA ~25%
- Coagulase-negative staph ~15%
- Strep species ~5%
Application to Clinical Practice
- It seems like either clindamycin or TMP-SMX are appropriate antimicrobial choices in uncomplicated wound infections.
- In this study, strep species were a minor component of the total cases. TMP-SMX is generally not strong against strep species, while clindamycin has good coverage.
- Consult your local antibiogram when appropriate. At our institution, clindamycin has poor in vitro susceptibility against MRSA.
References
Talan DA, et al. A randomized trial of clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated wound infection. Clin Infect Dis 2016;62(12):1505-13. [PMID 27025829]
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