Ampicillin/sulbactam and cefoxitin in the treatment of cutaneous and other soft-tissue abscesses in patients with or without histories of injection drug abuse.
A randomized, double-blind trial compared the clinical and bacteriologic efficacy of ampicillin/sulbactam (2 g/1 g) and cefoxitin (2 g) administered intravenously every 6 h to patients with (n=49) or without (n=47) histories of injection drug abuse who presented with cutaneous or other soft-tissue infections. Cure or improvement occurred in 89.8% of ampicillin/sulbactam-treated patients, compared with 93.6% of cefoxitin-treated patients. The median time to resolution of all symptoms was 10.5 days with ampicillin/sulbactam treatment and 15.5 days with cefoxitin treatment. Mixed aerobic-anaerobic infection was encountered frequently in both treatment groups. A significantly higher percentage of Streptococcus species was found in the major abscesses of the patients with histories of injection drug abuse, compared with those without such histories (37% vs. 19%, respectively; P=.0009). Overall, ampicillin/sulbactam eradicated pathogens from the major abscesses in 100% of patients, whereas the eradication rate with cefoxitin was 97.9%. The 2 drugs were well tolerated. Ampicillin/sulbactam and cefoxitin were equally effective for the empirical treatment of cutaneous or other soft-tissue infections in injection drug abusers and patients who did not inject drugs.
Talan
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DA
Department of Medicine, Division of Emergency Medicine and Infectious Diseases, Olive View-University of California Los Angeles Medical Center, Sylmar, CA 91342, USA. idnet@ucla.edu
Summanen
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PH
Finegold
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SM
D000038:Abscess / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D002440:Cefoxitin / Q000627:therapeutic use*; D002513:Cephamycins / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017192:Skin Diseases, Bacterial / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D018461:Soft Tissue Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013407:Sulbactam / Q000627:therapeutic use
D002513:Cephamycins; C035444:sultamicillin; D002440:Cefoxitin; D000667:Ampicillin; D013407:Sulbactam