title: Trimethoprim-Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess.
abstract: BACKGROUND
  U.S. emergency department visits for cutaneous abscess have increased with the emergence of methicillin-resistant Staphylococcus aureus (MRSA). The role of antibiotics for patients with a drained abscess is unclear.
  
  
  METHODS
  We conducted a randomized trial at five U.S. emergency departments to determine whether trimethoprim-sulfamethoxazole (at doses of 320 mg and 1600 mg, respectively, twice daily, for 7 days) would be superior to placebo in outpatients older than 12 years of age who had an uncomplicated abscess that was being treated with drainage. The primary outcome was clinical cure of the abscess, assessed 7 to 14 days after the end of the treatment period.
  
  
  RESULTS
  The median age of the participants was 35 years (range, 14 to 73); 45.3% of the participants had wound cultures that were positive for MRSA. In the modified intention-to-treat population, clinical cure of the abscess occurred in 507 of 630 participants (80.5%) in the trimethoprim-sulfamethoxazole group versus 454 of 617 participants (73.6%) in the placebo group (difference, 6.9 percentage points; 95% confidence interval [CI], 2.1 to 11.7; P=0.005). In the per-protocol population, clinical cure occurred in 487 of 524 participants (92.9%) in the trimethoprim-sulfamethoxazole group versus 457 of 533 participants (85.7%) in the placebo group (difference, 7.2 percentage points; 95% CI, 3.2 to 11.2; P<0.001). Trimethoprim-sulfamethoxazole was superior to placebo with respect to most secondary outcomes in the per-protocol population, resulting in lower rates of subsequent surgical drainage procedures (3.4% vs. 8.6%; difference, -5.2 percentage points; 95% CI, -8.2 to -2.2), skin infections at new sites (3.1% vs. 10.3%; difference, -7.2 percentage points; 95% CI, -10.4 to -4.1), and infections in household members (1.7% vs. 4.1%; difference, -2.4 percentage points; 95% CI, -4.6 to -0.2) 7 to 14 days after the treatment period. Trimethoprim-sulfamethoxazole was associated with slightly more gastrointestinal side effects (mostly mild) than placebo. At 7 to 14 days after the treatment period, invasive infections had developed in 2 of 524 participants (0.4%) in the trimethoprim-sulfamethoxazole group and in 2 of 533 participants (0.4%) in the placebo group; at 42 to 56 days after the treatment period, an invasive infection had developed in 1 participant (0.2%) in the trimethoprim-sulfamethoxazole group.
  
  
  CONCLUSIONS
  In settings in which MRSA was prevalent, trimethoprim-sulfamethoxazole treatment resulted in a higher cure rate among patients with a drained cutaneous abscess than placebo. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00729937.).
authors.affiliation: From the Departments of Emergency Medicine (D.A.T., A.K., F.M.A., G.J.M.) and Medicine, Division of Infectious Diseases (D.A.T., G.J.M.), Olive View-UCLA Medical Center, and the Department of Emergency Medicine, Ronald Reagan Medical Center (W.R.M), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles; the Department of Emergency Medicine, Maricopa Medical Center, University of Arizona, and Mayo Graduate School of Medicine - both in Phoenix (F.L.); the Department of Emergency Medicine, Temple University Medical Center, Temple University School of Medicine, Philadelphia (D.J.K.); the Department of Emergency Medicine, Truman Medical Center, University of Missouri School of Medicine, Kansas City (M.T.S.); the Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore (R.E.R.); and Cota Enterprises, McLouth, KS (R.H.).
authors.forename: David A
authors.initials: DA
authors.lastname: Talan
authors.affiliation: From the Departments of Emergency Medicine (D.A.T., A.K., F.M.A., G.J.M.) and Medicine, Division of Infectious Diseases (D.A.T., G.J.M.), Olive View-UCLA Medical Center, and the Department of Emergency Medicine, Ronald Reagan Medical Center (W.R.M), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles; the Department of Emergency Medicine, Maricopa Medical Center, University of Arizona, and Mayo Graduate School of Medicine - both in Phoenix (F.L.); the Department of Emergency Medicine, Temple University Medical Center, Temple University School of Medicine, Philadelphia (D.J.K.); the Department of Emergency Medicine, Truman Medical Center, University of Missouri School of Medicine, Kansas City (M.T.S.); the Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore (R.E.R.); and Cota Enterprises, McLouth, KS (R.H.).
authors.forename: William R
authors.initials: WR
authors.lastname: Mower
authors.affiliation: From the Departments of Emergency Medicine (D.A.T., A.K., F.M.A., G.J.M.) and Medicine, Division of Infectious Diseases (D.A.T., G.J.M.), Olive View-UCLA Medical Center, and the Department of Emergency Medicine, Ronald Reagan Medical Center (W.R.M), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles; the Department of Emergency Medicine, Maricopa Medical Center, University of Arizona, and Mayo Graduate School of Medicine - both in Phoenix (F.L.); the Department of Emergency Medicine, Temple University Medical Center, Temple University School of Medicine, Philadelphia (D.J.K.); the Department of Emergency Medicine, Truman Medical Center, University of Missouri School of Medicine, Kansas City (M.T.S.); the Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore (R.E.R.); and Cota Enterprises, McLouth, KS (R.H.).
authors.forename: Anusha
authors.initials: A
authors.lastname: Krishnadasan
authors.affiliation: From the Departments of Emergency Medicine (D.A.T., A.K., F.M.A., G.J.M.) and Medicine, Division of Infectious Diseases (D.A.T., G.J.M.), Olive View-UCLA Medical Center, and the Department of Emergency Medicine, Ronald Reagan Medical Center (W.R.M), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles; the Department of Emergency Medicine, Maricopa Medical Center, University of Arizona, and Mayo Graduate School of Medicine - both in Phoenix (F.L.); the Department of Emergency Medicine, Temple University Medical Center, Temple University School of Medicine, Philadelphia (D.J.K.); the Department of Emergency Medicine, Truman Medical Center, University of Missouri School of Medicine, Kansas City (M.T.S.); the Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore (R.E.R.); and Cota Enterprises, McLouth, KS (R.H.).
authors.forename: Fredrick M
authors.initials: FM
authors.lastname: Abrahamian
authors.affiliation: From the Departments of Emergency Medicine (D.A.T., A.K., F.M.A., G.J.M.) and Medicine, Division of Infectious Diseases (D.A.T., G.J.M.), Olive View-UCLA Medical Center, and the Department of Emergency Medicine, Ronald Reagan Medical Center (W.R.M), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles; the Department of Emergency Medicine, Maricopa Medical Center, University of Arizona, and Mayo Graduate School of Medicine - both in Phoenix (F.L.); the Department of Emergency Medicine, Temple University Medical Center, Temple University School of Medicine, Philadelphia (D.J.K.); the Department of Emergency Medicine, Truman Medical Center, University of Missouri School of Medicine, Kansas City (M.T.S.); the Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore (R.E.R.); and Cota Enterprises, McLouth, KS (R.H.).
authors.forename: Frank
authors.initials: F
authors.lastname: Lovecchio
authors.affiliation: From the Departments of Emergency Medicine (D.A.T., A.K., F.M.A., G.J.M.) and Medicine, Division of Infectious Diseases (D.A.T., G.J.M.), Olive View-UCLA Medical Center, and the Department of Emergency Medicine, Ronald Reagan Medical Center (W.R.M), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles; the Department of Emergency Medicine, Maricopa Medical Center, University of Arizona, and Mayo Graduate School of Medicine - both in Phoenix (F.L.); the Department of Emergency Medicine, Temple University Medical Center, Temple University School of Medicine, Philadelphia (D.J.K.); the Department of Emergency Medicine, Truman Medical Center, University of Missouri School of Medicine, Kansas City (M.T.S.); the Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore (R.E.R.); and Cota Enterprises, McLouth, KS (R.H.).
authors.forename: David J
authors.initials: DJ
authors.lastname: Karras
authors.affiliation: From the Departments of Emergency Medicine (D.A.T., A.K., F.M.A., G.J.M.) and Medicine, Division of Infectious Diseases (D.A.T., G.J.M.), Olive View-UCLA Medical Center, and the Department of Emergency Medicine, Ronald Reagan Medical Center (W.R.M), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles; the Department of Emergency Medicine, Maricopa Medical Center, University of Arizona, and Mayo Graduate School of Medicine - both in Phoenix (F.L.); the Department of Emergency Medicine, Temple University Medical Center, Temple University School of Medicine, Philadelphia (D.J.K.); the Department of Emergency Medicine, Truman Medical Center, University of Missouri School of Medicine, Kansas City (M.T.S.); the Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore (R.E.R.); and Cota Enterprises, McLouth, KS (R.H.).
authors.forename: Mark T
authors.initials: MT
authors.lastname: Steele
authors.affiliation: From the Departments of Emergency Medicine (D.A.T., A.K., F.M.A., G.J.M.) and Medicine, Division of Infectious Diseases (D.A.T., G.J.M.), Olive View-UCLA Medical Center, and the Department of Emergency Medicine, Ronald Reagan Medical Center (W.R.M), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles; the Department of Emergency Medicine, Maricopa Medical Center, University of Arizona, and Mayo Graduate School of Medicine - both in Phoenix (F.L.); the Department of Emergency Medicine, Temple University Medical Center, Temple University School of Medicine, Philadelphia (D.J.K.); the Department of Emergency Medicine, Truman Medical Center, University of Missouri School of Medicine, Kansas City (M.T.S.); the Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore (R.E.R.); and Cota Enterprises, McLouth, KS (R.H.).
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
authors.affiliation: From the Departments of Emergency Medicine (D.A.T., A.K., F.M.A., G.J.M.) and Medicine, Division of Infectious Diseases (D.A.T., G.J.M.), Olive View-UCLA Medical Center, and the Department of Emergency Medicine, Ronald Reagan Medical Center (W.R.M), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles; the Department of Emergency Medicine, Maricopa Medical Center, University of Arizona, and Mayo Graduate School of Medicine - both in Phoenix (F.L.); the Department of Emergency Medicine, Temple University Medical Center, Temple University School of Medicine, Philadelphia (D.J.K.); the Department of Emergency Medicine, Truman Medical Center, University of Missouri School of Medicine, Kansas City (M.T.S.); the Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore (R.E.R.); and Cota Enterprises, McLouth, KS (R.H.).
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hoagland
authors.affiliation: From the Departments of Emergency Medicine (D.A.T., A.K., F.M.A., G.J.M.) and Medicine, Division of Infectious Diseases (D.A.T., G.J.M.), Olive View-UCLA Medical Center, and the Department of Emergency Medicine, Ronald Reagan Medical Center (W.R.M), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles; the Department of Emergency Medicine, Maricopa Medical Center, University of Arizona, and Mayo Graduate School of Medicine - both in Phoenix (F.L.); the Department of Emergency Medicine, Temple University Medical Center, Temple University School of Medicine, Philadelphia (D.J.K.); the Department of Emergency Medicine, Truman Medical Center, University of Missouri School of Medicine, Kansas City (M.T.S.); the Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore (R.E.R.); and Cota Enterprises, McLouth, KS (R.H.).
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Moran
mesh_terms: D000038:Abscess / Q000188:drug therapy* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004322:Drainage; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017192:Skin Diseases, Bacterial / Q000188:drug therapy* / Q000628:therapy; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination