Thursday, March 17, 2011

Oral antibiotic therapy for cellulitis

HT to The Hospitalist for pointing me to this study in the American Journal of Medicine:

Treatment success rates for empiric therapy were compared among commonly prescribed antibiotics in our clinic: cephalexin, trimethoprim-sulfamethoxazole, and clindamycin...
The overall treatment success rate of trimethoprim-sulfamethoxazole was significantly higher than the rate of cephalexin (91% vs 74%; P<.001), whereas clindamycin success rates were higher than those of cephalexin in patients who had subsequently culture-confirmed MRSA infections (P=.01), had moderately severe cellulitis (P=.03), and were obese (P=.04). Methicillin-resistant S. aureus was recovered in 72 of 117 positive culture specimens (62%)...  
Antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, are preferred empiric therapy for outpatients with cellulitis in the community-associated MRSA-prevalent setting. 

It's concerning that these docs used bactrim monotherapy as one of the alternatives for treatment. That's against current recommendations because streptococci are still important pathogens and bactrim is not reliable against them. It there is a take home message form this study it's that you need to cover for Ca-MRSA also, at least in areas where it's prevalent. These days I don't know of any place where it's not.

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