Adjunctive antibiotics show efficacy for small skin infections

Adding antibiotic treatment to standard drainage of simple skin abscesses appears to improve healing, researchers reported on June 29, 2017 in the NEJM/New England Journal of Medicine. 

“We drained the abscess, measured it carefully to make sure it was less than five centimeters and then we randomized participants to receive a placebo or one of the antibiotics — clindamycin or TMP/SMX [trimethoprim-sulfamethoxazole]. What we saw is that in fact antibiotics are helpful. You are more likely to get better if you have antibiotics on board than if you don’t. And we also saw in children that clindamycin was associated with fewer recurrences in the one month of follow up,” said investigator Buddy Creech, M.D., associate professor of Pediatric Infectious Diseases at Vanderbilt University School of Medicine in Nashville, Tennessee, and director of the Vanderbilt Vaccine Research Program (VVRP).

The  researchers enrolled 786 subjects. Of these, 505 were adults and 281 were children.

Bacteria isolated from the abscesses included 527 staph samples and 388 samples identified as methicillin-resistant S. aureus (MRSA).

The investigators randomized the subjects to treatment with either  a placebo, clindamycin, or TMP/SMX for 10 days after the drainage of the abscess.

They reported that clindamycin and TMP/SMX were equally effective in adults, while clindamycin had a slightly higher cure rate in children and a higher rate of recurrence prevention.

Overall cure rates were 83 percent for adjunctive clindamycin, 82 percent for TMP/SMX and 70 percent for placebo.

Creech noted that physicians need to culture the abscess drainage so that infectious disease experts can track strains throughout the community and treat with appropriate antibiotics. For example, some subjects in this study had a clindamycin-resistant staph, rendering that antibiotic ineffective.

“Because antibiotics only work if the germ is susceptible to that antibiotic we really need to know the types of strains that are circulating in a community — not just for the individual patient but public health in general,” Creech said.