title: Comparative effectiveness of antibiotic treatment strategies for pediatric skin and soft-tissue infections.
abstract: OBJECTIVE
  To compare the effectiveness of clindamycin, trimethoprim-sulfamethoxazole, and β-lactams for the treatment of pediatric skin and soft-tissue infections (SSTIs).
  
  
  METHODS
  A retrospective cohort of children 0 to 17 years of age who were enrolled in Tennessee Medicaid, experienced an incident SSTI between 2004 and 2007, and received treatment with clindamycin (reference), trimethoprim-sulfamethoxazole, or a β-lactam was created. Outcomes included treatment failure and recurrence, defined as an SSTI within 14 days and between 15 and 365 days after the incident SSTI, respectively. Adjusted models stratified according to drainage status were used to estimate the risk of treatment failure and time to recurrence.
  
  
  RESULTS
  Among the 6407 children who underwent drainage, there were 568 treatment failures (8.9%) and 994 recurrences (22.8%). The adjusted odds ratios for treatment failure were 1.92 (95% confidence interval [CI]: 1.49-2.47) for trimethoprim-sulfamethoxazole and 2.23 (95% CI: 1.71-2.90) for β-lactams. The adjusted hazard ratios for recurrence were 1.26 (95% CI: 1.06-1.49) for trimethoprim-sulfamethoxazole and 1.42 (95% CI: 1.19-1.69) for β-lactams. Among the 41 094 children without a drainage procedure, there were 2435 treatment failures (5.9%) and 5436 recurrences (18.2%). The adjusted odds ratios for treatment failure were 1.67 (95% CI: 1.44-1.95) for trimethoprim-sulfamethoxazole and 1.22 (95% CI: 1.06-1.41) for β-lactams; the adjusted hazard ratios for recurrence were 1.30 (95% CI: 1.18-1.44) for trimethoprim-sulfamethoxazole and 1.08 (95% CI: 0.99-1.18) for β-lactams.
  
  
  CONCLUSIONS
  Compared with clindamycin, use of trimethoprim-sulfamethoxazole or β-lactams was associated with increased risks of treatment failure and recurrence. Associations were stronger for those with a drainage procedure.
authors.affiliation: Department of Pediatrics, School of Medicine and Monroe Carell Jr Children's Hospital, Vanderbilt University, Nashville, Tennessee 37232-2573, USA. derek.williams@vanderbilt.edu
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Williams
authors.forename: William O
authors.initials: WO
authors.lastname: Cooper
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kaltenbach
authors.forename: Judith A
authors.initials: JA
authors.lastname: Dudley
authors.forename: David L
authors.initials: DL
authors.lastname: Kirschke
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Jones
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Arbogast
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
authors.forename: C Buddy
authors.initials: CB
authors.lastname: Creech
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy*; D018461:Soft Tissue Infections / Q000188:drug therapy*; D013207:Staphylococcal Skin Infections; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D002981:Clindamycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination