Subgroup Analysis of Antibiotic Treatment for Skin Abscesses

David A Talan; Gregory J Moran; Anusha Krishnadasan; Fredrick M Abrahamian; Frank Lovecchio; David J Karras; Mark T Steele; Richard E Rothman; William R Mower

doi:10.1016/j.annemergmed.2017.07.483

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Subgroup Analysis of Antibiotic Treatment for Skin Abscesses

Journal article

Peer reviewed

Subgroup Analysis of Antibiotic Treatment for Skin Abscesses

David A Talan, Gregory J Moran, Anusha Krishnadasan, Fredrick M Abrahamian, Frank Lovecchio, David J Karras, Mark T Steele, Richard E Rothman and William R Mower

Annals of emergency medicine, Vol.71(1), pp.21-30

01/2018

DOI: 10.1016/j.annemergmed.2017.07.483

PMCID: PMC5741525

PMID: 28987525

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https://www.ncbi.nlm.nih.gov/pmc/articles/5741525View

Open Access

Abstract

Two large randomized trials recently demonstrated efficacy of methicillin-resistant Staphylococcus aureus (MRSA)-active antibiotics for drained skin abscesses. We determine whether outcome advantages observed in one trial exist across lesion sizes and among subgroups with and without guideline-recommended antibiotic indications. We conducted a planned subgroup analysis of a double-blind, randomized trial at 5 US emergency departments, demonstrating superiority of trimethoprim-sulfamethoxazole (320/1,600 mg twice daily for 7 days) compared with placebo for patients older than 12 years with a drained skin abscess. We determined between-group differences in rates of clinical (no new antibiotics) and composite cure (no new antibiotics or drainage) through 7 to 14 and 42 to 56 days after treatment among subgroups with and without abscess cavity or erythema diameter greater than or equal to 5 cm, history of MRSA, fever, diabetes, and comorbidities. We also evaluated treatment effect by lesion size and culture result. Among 1,057 mostly adult participants, median abscess cavity and erythema diameters were 2.5 cm (range 0.1 to 16.0 cm) and 6.5 cm (range 1.0 to 38.5), respectively; 44.3% grew MRSA. Overall, for trimethoprim-sulfamethoxazole and placebo groups, clinical cure rate at 7 to 14 days was 92.9% and 85.7%; composite cure rate at 7 to 14 days was 86.5% and 74.3%, and at 42 to 56 days, it was 82.4% and 70.2%. For all outcomes, across lesion sizes and among subgroups with and without guideline antibiotic criteria, trimethoprim-sulfamethoxazole was associated with improved outcomes. Treatment effect was greatest with history of MRSA infection, fever, and positive MRSA culture. Treatment with trimethoprim-sulfamethoxazole was associated with improved outcomes regardless of lesion size or guideline antibiotic criteria.

Abscess - drug therapy

Adolescent

Adult

Aged

Anti-Bacterial Agents - therapeutic use

Double-Blind Method

Drug Administration Schedule

Female

Follow-Up Studies

Humans

Male

Middle Aged

Skin Diseases, Bacterial - drug therapy

Staphylococcal Skin Infections - drug therapy

Streptococcal Infections - drug therapy

Treatment Outcome

Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use

Young Adult

Details

Title: Subtitle: Subgroup Analysis of Antibiotic Treatment for Skin Abscesses
Creators: David A Talan - University of California, Los Angeles
Gregory J Moran - University of California, Los Angeles
Anusha Krishnadasan - Olive View-UCLA Medical Center
Fredrick M Abrahamian - University of California, Los Angeles
Frank Lovecchio - Maricopa Medical Center
David J Karras - Temple University
Mark T Steele - Truman Medical Center
Richard E Rothman - Johns Hopkins University
William R Mower - Ronald Reagan UCLA Medical Center
Resource Type: Journal article
Publication Details: Annals of emergency medicine, Vol.71(1), pp.21-30
DOI: 10.1016/j.annemergmed.2017.07.483
PMID: 28987525
PMCID: PMC5741525
NLM abbreviation: Ann Emerg Med
ISSN: 0196-0644
eISSN: 1097-6760
Grant note: HHSN272200700032C / NIAID NIH HHS
Language: English
Date published: 01/2018
Academic Unit: Emergency Medicine; Internal Medicine
Record Identifier: 9984296983002771

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