Annals of Emergency Medicine
Volume 56, Issue 3 , Pages 283-287, September 2010

Randomized Controlled Trial of Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Abscesses in Patients at Risk for Community-Associated Methicillin-Resistant Staphylococcus aureus Infection

Presented as an abstract at the Society of Air Force Clinical Surgeons, April 2009, Denver, CO; the Leadership and Advocacy Conference, April 2009, Washington, DC; and the Scientific Assembly, ACEP Research Forum, October 2009, Boston, MA.

  • Gillian R. Schmitz, MD

      Affiliations

    • Department of Emergency Medicine, Washington Hospital Center, Washington, DC
    • Corresponding Author InformationAddress for correspondence: Gillian R. Schmitz, MD, 714 Carpenter Rd, Alexandria, VA 22314; 202-877-7632, fax 202-877-2468
    • ,
  • David Bruner, MD

      Affiliations

    • Department of Emergency Medicine, Naval Medical Center, Portsmouth, VA
    • ,
  • Rebecca Pitotti, RN, BSN

      Affiliations

    • Department of Emergency Medicine, Wilford Hall Medical Center, Lackland Air Force Base, TX
    • ,
  • Cameron Olderog, MD

      Affiliations

    • Department of Emergency Medicine, Brooke Army Medical Center, Ft. Sam Houston, TX
    • ,
  • Timothy Livengood, MD

      Affiliations

    • Department of Emergency Medicine, Brooke Army Medical Center, Ft. Sam Houston, TX
    • ,
  • Justin Williams, MD

      Affiliations

    • Department of Emergency Medicine, Brooke Army Medical Center, Ft. Sam Houston, TX
    • ,
  • Kermit Huebner, MD

      Affiliations

    • Department of Emergency Medicine, Darnall Army Medical Center, Ft. Hood, TX
    • ,
  • Jeffrey Lightfoot, MD

      Affiliations

    • Department of Emergency Medicine, Naval Medical Center, Portsmouth, VA
    • ,
  • Brandon Ritz, MD

      Affiliations

    • Department of Emergency Medicine, Darnall Army Medical Center, Ft. Hood, TX
    • ,
  • Christopher Bates, MD

      Affiliations

    • Department of Emergency Medicine, Wilford Hall Medical Center, Lackland Air Force Base, TX
    • ,
  • Matthew Schmitz, MD

      Affiliations

    • Department of Orthopaedic Surgery, Wilford Hall Medical Center, Lackland Air Force Base, TX
    • ,
  • Mihriye Mete, PhD

      Affiliations

    • Departments of Epidemiology and Statistics, Medstar Research Institute, Hyattsville, MD
    • ,
  • Gregory Deye, MD

      Affiliations

    • Department of Clinical Pharmacology, Walter Reed Army Institute of Research, Silver Spring, MD

Received 20 January 2010; received in revised form 11 February 2010; accepted 1 March 2010. published online 29 March 2010.

Study objective

Community-associated methicillin-resistant Staphylococcus aureus is now the leading cause of uncomplicated skin abscesses in the United States, and the role of antibiotics is controversial. We evaluate whether trimethoprim-sulfamethoxazole reduces the rate of treatment failures during the 7 days after incision and drainage and whether it reduces new lesion formation within 30 days.

Methods

In this multicenter, double-blind, randomized, placebo-controlled trial, we randomized adults to oral trimethoprim-sulfamethoxazole or placebo after uncomplicated abscess incision and drainage. Using emergency department rechecks at 2 and 7 days and telephone follow-up, we assessed treatment failure within 7 days, and using clinical follow-up, telephone follow-up, and medical record review, we recorded the development of new lesions within 30 days.

Results

We randomized 212 patients, and 190 (90%) were available for 7-day follow-up. We observed a statistically similar incidence of treatment failure in patients receiving trimethoprim-sulfamethoxazole (15/88; 17%) versus placebo (27/102; 26%), difference 9%, 95% confidence interval –2% to 21%; P=.12. On 30-day follow-up (successful in 69% of patients), we observed fewer new lesions in the antibiotic (4/46; 9%) versus placebo (14/50; 28%) groups, difference 19%, 95% confidence interval 4% to 34%, P=.02.

Conclusion

After the incision and drainage of uncomplicated abscesses in adults, treatment with trimethoprim-sulfamethoxazole does not reduce treatment failure but may decrease the formation of subsequent lesions.

 

 The opinions expressed in this document are solely those of the authors and do not represent an endorsement by or the views of the United States Air Force, the Department of Defense, or the United States Government.

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

 Supervising editor: Steven M. Green, MD

 Author contributions: GRS and DB conceived the study, designed the trial, and performed the majority of data collection. GRS obtained research funding and drafted the article. GRS, DB, JW, and KH were the primary investigators at each of the 4 study sites and oversaw the conduct of the trial. RP enrolled many of the patients and updated and maintained the databases. RP, CO, TL, JL, BR, and CB made follow-up telephone calls. CO, TL, JL, BR, and CB helped collect data and maintain the study at each site. MS assisted with editing, background research, and writing the article. MM performed the statistical analysis. GD provided feedback for the grant and assisted with editing and writing the article. All authors contributed to revision of the article. GRS takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This research was funded by EMF EMBRS grant 2007-2008) and the Surgeon General's Office.

 Publication date: Available online March 26, 2010.

 Please see page 284 for the Editor's Capsule Summary of this article.

PII: S0196-0644(10)00218-0

doi:10.1016/j.annemergmed.2010.03.002

Annals of Emergency Medicine
Volume 56, Issue 3 , Pages 283-287, September 2010