title: A Randomized Trial of Clindamycin Versus Trimethoprim-sulfamethoxazole for Uncomplicated Wound Infection.
abstract: With the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) in the United States, visits for skin infections greatly increased. Staphylococci and streptococci are considered predominant causes of wound infections. Clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX) are commonly prescribed, but the efficacy of TMP-SMX has been questioned.
  
  
  
  We conducted a randomized, double-blind, superiority trial at 5 US emergency departments. Patients >12 years of age with an uncomplicated wound infection received oral clindamycin 300 mg 4 times daily or TMP-SMX 320 mg/1600 mg twice daily, each for 7 days. We compared the primary outcome, wound infection cure at 7-14 days, and secondary outcomes through 6-8 weeks after treatment, in the per-protocol population.
  
  
  
  Subjects had a median age of 40 years (range, 14-76 years); 40.1% of wound specimens grew MRSA, 25.7% methicillin-susceptible S. aureus, and 5.0% streptococci. The wound infection was cured at 7-14 days in 187 of 203 (92.1%) clindamycin-treated and 182 of 198 (91.9%) TMP-SMX-treated subjects (difference, 0.2%; 95% confidence interval [CI], -5.8% to 6.2%; P = not significant). The clindamycin group had a significantly lower rate of recurrence at 7-14 days (1.5% vs 6.6%; difference, -5.1%; 95% CI, -9.4% to -.8%) and through 6-8 weeks following treatment (2.0% vs 7.1%; difference, -5.1%; 95% CI, -9.7% to -.6%). Other secondary outcomes were statistically similar between groups but tended to favor clindamycin. Adverse event rates were similar.
  
  
  
  In settings where MRSA is prevalent, clindamycin and TMP-SMX produce similar cure and adverse event rates among patients with an uncomplicated wound infection. Further study evaluating differential effects of antibiotics on recurrent infection may be warranted.
  
  
  
  NCT00729937.
authors.affiliation: Department of Emergency Medicine.|Division of Infectious Diseases, Department of Medicine, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA.
authors.forename: David A
authors.initials: DA
authors.lastname: Talan
authors.affiliation: Department of Emergency Medicine, Maricopa Medical Center, University of Arizona and Mayo Graduate School of Medicine, Phoenix.
authors.forename: Frank
authors.initials: F
authors.lastname: Lovecchio
authors.affiliation: Departmentof Emergency Medicine.
authors.forename: Fredrick M
authors.initials: FM
authors.lastname: Abrahamian
authors.affiliation: Department of Emergency Medicine, Temple University Medical Center, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Karras
authors.affiliation: Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City School of Medicine.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Steele
authors.affiliation: Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
authors.affiliation: Departmentof Emergency Medicine.
authors.forename: Anusha
authors.initials: A
authors.lastname: Krishnadasan
authors.affiliation: Department of Emergency Medicine, Ronald Reagan Medical Center, David Geffen School of Medicine at UCLA.
authors.forename: William R
authors.initials: WR
authors.lastname: Mower
authors.affiliation: Cota Enterprises, Inc, McLouth, Kansas.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hoagland
authors.affiliation: Department of Emergency Medicine.|Division of Infectious Diseases, Department of Medicine, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Moran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000188:drug therapy; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D014481:United States; D014946:Wound Infection / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: clindamycin; methicillin-resistant Staphylococcus aureus; randomized; trimethoprim-sulfamethoxazole; wound infection