Trimethoprim-Sulfamethoxazole vs Placebo for Uncomplicated Skin Abscess

Recently, U.S. emergency department visits for a methicillin-resistant MRSA have increased. Currently it is not clear what role antibiotics play for a drained abscess. The investigators conducting this randomized trial selected five emergency departments in the U.S. in order to figure out if trimethoprim-sulfamethoxazole (320 mg or 1600 mg twice daily) would be more effective than a placebo for an uncomplicated abscess. The primary outcome was curing the abscess. An assessment took place 7 to 14 days after the end of treatment. The participants in the study were outpatients older than 12 years old.

Overall, trimethoprim-sulfamethoxazole was more effective than placebo for increasing the cure rate for patients with a drained cutaneous abscess. This in turn resulted in a lower rate for surgical drainage procedures, skin infections at new sites, and infections among household members. I actually had a friend who recently had this condition and throughout the week had to get the abscess periodically drained, which was not a pleasant procedure. It is nice to see that research is progressing on this topic to prevent more people from having to go through this procedure often.

Talan DA, Mower WR, Krishnadasan A, et al. Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess. N Engl J Med. 2016;374:823-32.

 

Is Trimethoprim-Sulfamethoxazole a Valid Alternative in the Management of Infections in Children in the Era of Community-Acquired Methicillin-Resistant Staphylococcus aureus? A Comprehensive Systematic Review

One of the growing problems in he practice of pharmacy is the increasing emergence of strains of bacteria immune to the antibiotics that are currently on the market. Through over-prescribing, non-adherence, and other contributing factors, the need for new antibiotics is as high as it was when penicillin was first discovered. But as we all know, a drug doesn’t hit the market immediately. It can be over 10 years to before a drug is approved so what are we supposed to do in that time? Let the bacteria beat our current antibiotics? Or is there something more we can do to combat antibiotic resistance.

 

Rosanova et. al reviewed the literature to determine if trimethoprim-sulfamethoxazole had been proven to effectively treat Methicillin-Resistant Staphylococcus aureus (MRSA) in children. According to the first consult page on MRSA on clinicalkey, the outpatient treatment of MRSA includes drugs like clindamycin and linezolid for both pediatrics and adults. It also mentions trimethoprim-sulfamethoxazole as a treatment but only in adults. The review done by Rosanova et al found just 4 primary articles that studied trimethoprim-sulfamethoxazole in a randomized controlled study in children and the results were inconclusive.

 

While the findings of this article may not be significant, the fact that it was even written is. This article proves that while we work to discover newer and more effective antibiotics, we must also reevaluate the ones we currently use and find other possible uses for them.

 

Rosanova, M. T., Pompa, L. C., Perez, G., Sberna, N., Serrano-Aguilar, P., & Lede, R. (2016). Is Trimethoprim-Sulfamethoxazole a Valid Alternative in the Management of Infections in Children in the Era of Community-Acquired Methicillin-Resistant Staphylococcus aureus? A Comprehensive Systematic Review. Journal of Pharmacy Technology, 32(2), 81-87. Retrieved February 22, 2016.