Skin Diseases, Infectious Clinical Trial
Official title:
Effective Duration of Antibiotic Treatment of Community-Acquired Methicillin-Resistant Staphylococcus Aureus (MRSA)
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.
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At our institution, it is estimated that 60-70% (unpublished observation) of cultured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.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
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