title: Randomized controlled trial of cephalexin versus clindamycin for uncomplicated pediatric skin infections.
abstract: OBJECTIVE
  To compare clindamycin and cephalexin for treatment of uncomplicated skin and soft tissue infections (SSTIs) caused predominantly by community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA). We hypothesized that clindamycin would be superior to cephalexin (an antibiotic without MRSA activity) for treatment of these infections.
  
  
  METHODS
  Patients aged 6 months to 18 years with uncomplicated SSTIs not requiring hospitalization were enrolled September 2006 through May 2009. Eligible patients were randomly assigned to 7 days of cephalexin or clindamycin; primary and secondary outcomes were clinical improvement at 48 to 72 hours and resolution at 7 days. Cultures were obtained and tested for antimicrobial susceptibilities, pulsed-field gel electrophoresis type, and Panton-Valentine leukocidin status.
  
  
  RESULTS
  Of 200 enrolled patients, 69% had MRSA cultured from wounds. Most MRSA were USA300 or subtypes, positive for Panton-Valentine leukocidin, and clindamycin susceptible, consistent with CA-MRSA. Spontaneous drainage occurred or a drainage procedure was performed in 97% of subjects. By 48 to 72 hours, 94% of subjects in the cephalexin arm and 97% in the clindamycin arm were improved (P = .50). By 7 days, all subjects were improved, with complete resolution in 97% in the cephalexin arm and 94% in the clindamycin arm (P = .33). Fevers and age less than 1 year, but not initial erythema > 5 cm, were associated with early treatment failures, regardless of antibiotic used.
  
  
  CONCLUSIONS
  There is no significant difference between cephalexin and clindamycin for treatment of uncomplicated pediatric SSTIs caused predominantly by CA-MRSA. Close follow-up and fastidious wound care of appropriately drained, uncomplicated SSTIs are likely more important than initial antibiotic choice.
authors.affiliation: Johns Hopkins University, Department of Pediatrics, Division of Pediatric Emergency Medicine, CMSC 144, 600 N Wolfe St, Baltimore, MD 21287, USA. achen33@jhmi.edu
authors.forename: Aaron E
authors.initials: AE
authors.lastname: Chen
authors.forename: Karen C
authors.initials: KC
authors.lastname: Carroll
authors.forename: Marie
authors.initials: M
authors.lastname: Diener-West
authors.forename: Tracy
authors.initials: T
authors.lastname: Ross
authors.forename: Joyce
authors.initials: J
authors.lastname: Ordun
authors.forename: Mitchell A
authors.initials: MA
authors.lastname: Goldstein
authors.forename: Gaurav
authors.initials: G
authors.lastname: Kulkarni
authors.forename: J B
authors.initials: JB
authors.lastname: Cantey
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002506:Cephalexin / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013207:Staphylococcal Skin Infections / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D002506:Cephalexin