SOURCE: Miller LG, et al. N Engl J Med 2015;372:1093-1103.

The treatment of cellulitis, with or without a local abscess, has become more complicated since MRSA (methicillin-resistant Staphylococcus aureus) has assumed the causal role of “guilty until proven otherwise” in such settings. Although there has been some suggestion in the literature that antibiotic treatment may not be necessary once an abscess — even a MRSA abscess — has been incised and drained, oftentimes there is sufficient cellulitis surrounding the abscess that clinicians may feel uneasy to omit antibiotics. Hence, the decision for treatment of uncomplicated skin infections boils down to which antibiotic?

Miller et al performed a double-blind, randomized comparison trial among patients (n = 524) with cellulitis and/or abscess, including 155 children. Subjects were randomized to treatment with 10 days of either oral clindamycin (CLIN) or trimethoprim-sulfamethoxazole (TMP-SMX). The primary outcome of the trial was clinical cure at 7-10 days post-antibiotic treatment.

There was no difference in clinical cure rate between the two treatment arms, nor was there any meaningful difference in adverse events, including Clostridium difficile-associated diarrhea (no cases, either treatment arm). The efficacy and safety of CLIN and TMP-SMX for uncomplicated skin infections appear comparable.