title: Trimethoprim-Sulfamethoxazole Therapy Reduces Failure and Recurrence in Methicillin-Resistant Staphylococcus aureus Skin Abscesses after Surgical Drainage.
abstract: OBJECTIVE
  To determine whether a 3-day vs 10-day course of antibiotics after surgical drainage of skin abscesses is associated with different failure and recurrence rates.
  
  
  METHODS
  Patients age 3 months to 17 years seeking care at a pediatric emergency department with an uncomplicated skin abscess that required surgical drainage were randomized to receive 3 or 10 days of oral trimethoprim-sulfamethoxazole therapy. Patients were evaluated 10-14 days later to assess clinical outcome. Patients were followed for 6 months to determine the cumulative rate of recurrent skin infections.
  
  
  RESULTS
  Among the 249 patients who were enrolled, 87% of wound cultures grew Staphylococcus aureus (S aureus) (55% methicillin-resistant S aureus [MRSA], 32% methicillin-sensitive S aureus), 11% other organisms, and 2% no growth. Thirteen patients experienced treatment failure. Among all patients, no significant difference in failure rates between the 3- and 10-day treatment groups was found. After we stratified patients by the infecting organism, only patients with MRSA infection were more likely to experience treatment failure in the 3-day group than the 10-day group (P = .03, rate difference 10.1%, 95% CI 2.1%-18.2%) Recurrent infection within 1 month of surgical drainage was more likely in patients infected with MRSA who received 3 days of antibiotics. (P = .046, rate difference 10.3%, 95% CI 0.8%-19.9%).
  
  
  CONCLUSIONS
  Patients with MRSA skin abscesses are more likely to experience treatment failure and recurrent skin infection if given 3 rather than 10 days of trimethoprim-sulfamethoxazole after surgical drainage.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT02024867.
authors.affiliation: University at Buffalo, Buffalo, NY; Women & Children's Hospital of Buffalo, Buffalo, NY. Electronic address: LHolmes@upa.chob.edu.
authors.forename: Lucy
authors.initials: L
authors.lastname: Holmes
authors.affiliation: University at Buffalo, Buffalo, NY.
authors.forename: Changxing
authors.initials: C
authors.lastname: Ma
authors.affiliation: Women & Children's Hospital of Buffalo, Buffalo, NY.
authors.forename: Haiping
authors.initials: H
authors.lastname: Qiao
authors.affiliation: Women & Children's Hospital of Buffalo, Buffalo, NY.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Drabik
authors.affiliation: Women & Children's Hospital of Buffalo, Buffalo, NY.
authors.forename: Colleen
authors.initials: C
authors.lastname: Hurley
authors.affiliation: Women & Children's Hospital of Buffalo, Buffalo, NY.
authors.forename: Donna
authors.initials: D
authors.lastname: Jones
authors.affiliation: Women & Children's Hospital of Buffalo, Buffalo, NY.
authors.forename: Sarah
authors.initials: S
authors.lastname: Judkiewicz
authors.affiliation: University at Buffalo, Buffalo, NY; Women & Children's Hospital of Buffalo, Buffalo, NY.
authors.forename: Howard
authors.initials: H
authors.lastname: Faden
mesh_terms: D000038:Abscess / Q000188:drug therapy*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D012008:Recurrence; D013207:Staphylococcal Skin Infections / Q000188:drug therapy*; D017211:Treatment Failure; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination