Effective Antibiotic Treatment of MRSA

Christiana Care Health Services

Status: Completed

Conditions: Skin Diseases, Infectious

Treatments: Procedure: Culture

Study type: Interventional

Funder types: Other

Identifiers

NCT00388310

26018

Details and patient eligibility

About

To evaluate the effective duration (in days) to clinical improvement of outpatient antibiotic regimens in the treatment of superficial abscesses caused by MRSA in patients that present to the emergency department.

Full description

Skin and soft tissue infections-cellulitis, furuncles, carbuncles, and abscesses-make up approximately 1-2% of emergency room visits annually. While abscesses are generally incised and drained, there is no definite standard treatment regimen or duration of treatment that practitioners have adhered to regarding antibiotic use. Historical evidence suggests that antibiotics may not be necessary for simple superficial abscesses, though a number of antibiotics-including penicillins and cephalosporins-may be used for treatment of large and/or complicated abscesses. These antibiotics however are ineffective against what is becoming an increasingly common pathogen- community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA).

At our institution, it is estimated that 60-70% (unpublished observation) of cultured abscesses are caused by CA-MRSA. These patients have generally been treated with incision and drainage, with the addition of an antibiotic left to the practitioner's discretion. Also, there has been no universally accepted duration of treatment established to observe clinical improvement of such abscesses. Common antibiotic regimens range from 7-14 days of treatment for cellulitic infections. While there has been one prospective trial regarding the use of antibiotics in simple abscesses, there has been no published prospective study on the use of antibiotics in treating CA-MRSA abscesses in adults. Furthermore, while 7-14 days of treatment seems the recommended duration of treating cellulitic infections, no study has evaluated the duration of treatment needed to observe clinical improvement of abscesses caused by CA-MRSA. We wish to prospectively evaluate the duration of treatment necessary to observe clinical improvement of abscesses caused by CA-MRSA among multiple different antibiotics (ie. cephalexin, clindamycin, and trimethoprim/sulfamethoxazole) after standard incision and drainage in patients presenting to the emergency department.

Enrollment: 33 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• All patients age 18 and older, presenting to the emergency department with an abscess with a diameter greater than three centimeters
• Informed consent

Exclusion criteria

• Patients who are presumed to have community-acquired pathogens
• Under 18
• Abscess less than three centimeters in diameter

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)

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33 participants in 4 patient groups, including a placebo group

Cephalexin

Active Comparator group

Description:

Cephalexin 250 mg PO q6h x5 days

Treatment:

Procedure: Culture

Clindamycin

Active Comparator group

Description:

Clindamycin 300 mg PO q6h x5 days

Treatment:

Procedure: Culture

trimethoprim/sulfamethoxazole

Active Comparator group

Description:

trimethoprim/sulfamethoxazole 160 mg/800 mg PO q12h x 5 days

Treatment:

Procedure: Culture

Placebo

Placebo Comparator group

Treatment:

Procedure: Culture