Tags

Type your tag names separated by a space and hit enter

Empiric antimicrobial therapy for pediatric skin and soft-tissue infections in the era of methicillin-resistant Staphylococcus aureus.
Pediatrics. 2009 Jun; 123(6):e959-66.Ped

Abstract

OBJECTIVE

The goal was to compare the clinical effectiveness of monotherapy with beta-lactams, clindamycin, or trimethoprim-sulfamethoxazole in the outpatient management of nondrained noncultured skin and soft-tissue infections (SSTIs), in a methicillin-resistant Staphylococcus aureus (MRSA)-endemic region.

METHODS

A retrospective, nested, case-control trial was conducted with a cohort of patients from 5 urban pediatric practices in a community-acquired MRSA-endemic region. All subjects were treated as outpatients with oral monotherapy for nondrained noncultured SSTIs between January 2004 and March 2007. The primary outcome was treatment failure, defined as a drainage procedure, hospitalization, change in antibiotic, or second antibiotic prescription within 28 days.

RESULTS

Of 2096 children with nondrained noncultured SSTIs, 104 (5.0%) were identified as experiencing treatment failure and were matched to 480 control subjects. Compared with beta-lactam therapy, clindamycin was equally effective but trimethoprim-sulfamethoxazole was associated with an increased risk of failure. Other factors independently associated with failure included initial treatment in the emergency department, presence or history of fever, and presence of either induration or a small abscess.

CONCLUSIONS

Compared with beta-lactams, clindamycin monotherapy conferred no benefit, whereas trimethoprim-sulfamethoxazole was associated with an increased risk of treatment failure in a cohort of children with nondrained noncultured SSTIs who were treated as outpatients. Even in regions with endemic community-acquired MRSA, beta-lactams may still be appropriate, first-line, empiric therapy for children presenting with these infections.

Authors+Show Affiliations

Christiana Care Health System, Christiana Hospital, Room 4B01, 4755 Ogletown-Stanton Rd, Newark, DE 19718, USA. delliott@christianacare.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

19470525

Citation

Elliott, Daniel J., et al. "Empiric Antimicrobial Therapy for Pediatric Skin and Soft-tissue Infections in the Era of Methicillin-resistant Staphylococcus Aureus." Pediatrics, vol. 123, no. 6, 2009, pp. e959-66.
Elliott DJ, Zaoutis TE, Troxel AB, et al. Empiric antimicrobial therapy for pediatric skin and soft-tissue infections in the era of methicillin-resistant Staphylococcus aureus. Pediatrics. 2009;123(6):e959-66.
Elliott, D. J., Zaoutis, T. E., Troxel, A. B., Loh, A., & Keren, R. (2009). Empiric antimicrobial therapy for pediatric skin and soft-tissue infections in the era of methicillin-resistant Staphylococcus aureus. Pediatrics, 123(6), e959-66. https://doi.org/10.1542/peds.2008-2428
Elliott DJ, et al. Empiric Antimicrobial Therapy for Pediatric Skin and Soft-tissue Infections in the Era of Methicillin-resistant Staphylococcus Aureus. Pediatrics. 2009;123(6):e959-66. PubMed PMID: 19470525.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Empiric antimicrobial therapy for pediatric skin and soft-tissue infections in the era of methicillin-resistant Staphylococcus aureus. AU - Elliott,Daniel J, AU - Zaoutis,Theoklis E, AU - Troxel,Andrea B, AU - Loh,Andrew, AU - Keren,Ron, Y1 - 2009/05/26/ PY - 2009/5/28/entrez PY - 2009/5/28/pubmed PY - 2009/6/18/medline SP - e959 EP - 66 JF - Pediatrics JO - Pediatrics VL - 123 IS - 6 N2 - OBJECTIVE: The goal was to compare the clinical effectiveness of monotherapy with beta-lactams, clindamycin, or trimethoprim-sulfamethoxazole in the outpatient management of nondrained noncultured skin and soft-tissue infections (SSTIs), in a methicillin-resistant Staphylococcus aureus (MRSA)-endemic region. METHODS: A retrospective, nested, case-control trial was conducted with a cohort of patients from 5 urban pediatric practices in a community-acquired MRSA-endemic region. All subjects were treated as outpatients with oral monotherapy for nondrained noncultured SSTIs between January 2004 and March 2007. The primary outcome was treatment failure, defined as a drainage procedure, hospitalization, change in antibiotic, or second antibiotic prescription within 28 days. RESULTS: Of 2096 children with nondrained noncultured SSTIs, 104 (5.0%) were identified as experiencing treatment failure and were matched to 480 control subjects. Compared with beta-lactam therapy, clindamycin was equally effective but trimethoprim-sulfamethoxazole was associated with an increased risk of failure. Other factors independently associated with failure included initial treatment in the emergency department, presence or history of fever, and presence of either induration or a small abscess. CONCLUSIONS: Compared with beta-lactams, clindamycin monotherapy conferred no benefit, whereas trimethoprim-sulfamethoxazole was associated with an increased risk of treatment failure in a cohort of children with nondrained noncultured SSTIs who were treated as outpatients. Even in regions with endemic community-acquired MRSA, beta-lactams may still be appropriate, first-line, empiric therapy for children presenting with these infections. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/19470525/Empiric_antimicrobial_therapy_for_pediatric_skin_and_soft_tissue_infections_in_the_era_of_methicillin_resistant_Staphylococcus_aureus_ L2 - https://publications.aap.org/pediatrics/article-lookup/doi/10.1542/peds.2008-2428 DB - PRIME DP - Unbound Medicine ER -