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Here’s When EDs Should Increase Usage of Antibiotics

Emergency clinicians are under a lot of pressure to reduce antibiotic prescribing, so it is news when a study suggests the medications aren’t being used enough in a specific situation.

A study published in Clinical Infectious Diseases discusses the dilemma faced in EDs when children present with uncomplicated Staphylococcus aureus infections.

Washington University School of Medicine in St. Louis researchers and colleagues found that prescribing antibiotics, in combination with lancing and draining affected areas, reduces the risk of recurrent infections.

“There have been conflicting data about the benefit to antibiotics in minor staph infections,” explained senior author Stephanie A. Fritz, MD, a Washington University associate professor of pediatrics in the Division of Infectious Diseases. “It is definitely important to surgically remove pus from the infection site, but also giving antibiotics means that the child will be less likely to see a doctor again in several months for another staph infection.”

To come to that conclusion, researchers focused on 383 children with a median age of 3 years old, whose staph infections required incision and drainage. Most of the patients who also had colonization of staph in their nostrils or on their skin were prescribed antibiotics.

The children were evaluated for the bacteria and reinfection numerous times over a year. A month after initial infection, bacterial swab tests found that half of the children who had received antibiotics had no signs of staph living on their skin or in their nostrils, reducing the risk of recurring infection.

Of the 7% who were not prescribed antibiotics, however, three-quarters still had signs of the bacteria colonized on their skin. Those children also were about twice as likely to experience a recurrent infection than those who did not have residual cutaneous staph.

“In recent years, studies have demonstrated that staph infections are prominent in both hospitals and in the community,” Fritz said. “For example, we have seen a dramatic increase in community-associated infections since 2000.”

Acknowledging that it may appear to be counterintuitive, the study states that prescribing antibiotics for minor staph infections actually helps to reduce antibiotic resistance.

“Using antibiotics judiciously to treat staph infections eliminates staph colonization and prevents more infection from occurring in the future,” said first author Patrick Hogan, MPH, a clinical research specialist at Washington University. “This reduces the overall burden of the staph germ on the environment and people, which results in less recurrence and, therefore, less antibiotic use.”

Results also indicated that clindamycin was more effective than trimethoprim-sulfamethoxazole (TMP-SMX) in eradicating S. aureus colonization — 44% vs. 57% remained colonized; and more effective in preventing recurrent SSTI — 31% vs. 47% experienced recurrence.

“Systemic antibiotics, as part of acute SSTI management, impact S. aureus colonization, contributing to a decreased incidence of recurrent SSTI,” the researchers concluded. “The mechanism by which clindamycin differentially affects colonization and recurrent SSTI compared to TMP-SMX warrants further study.”