TY - JOUR
T1 - Subgroup Analysis of Antibiotic Treatment for Skin Abscesses
AU - Talan, David A.
AU - Moran, Gregory J.
AU - Krishnadasan, Anusha
AU - Abrahamian, Fredrick M.
AU - Lovecchio, Frank
AU - Karras, David J.
AU - Steele, Mark T.
AU - Rothman, Richard E.
AU - Mower, William R.
N1 - Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Supported by a contract from the National Institutes of Allergy and Infectious Diseases (NIAID) (HHSN272200700032C to Drs. Talan and Moran). Dr. Talan reports personal fees for consultation from Allergan, GlaxoSmithKline, and Paratek Pharmaceuticals and research grants from Allergan, Debiopharm, the Centers for Disease Control and Prevention (CDC), and the Patient Centered Outcomes Research Institute. Dr. Moran reports personal fees for consultation and research grants from Allergan, Cempra, ContraFect, YES Biotechnology, the CDC, and the Patient Centered Outcomes Research Institute. Dr. Krishnadasan reports research grants from the CDC and the Patient Centered Outcomes Research Institute. Dr. Abrahamian reports personal fees from participation on speakers bureaus for Merck, Allergan, and The Medicines Company; consultation for Cempra, Summit Therapeutics, Tetraphase Pharmaceuticals, Paratek Pharmaceuticals, and Janssen Research & Development; and research grants from the CDC, Merck, and Cempra. Dr. Lovecchio reports research grants from Allergan, the National Institutes of Health (NIH), and the CDC. Dr. Steele reports research grants from Allergan and the CDC. Dr. Rothman reports personal fees for consultation and research grants from Allergan, Gilead (FOCUS Program), CDC, NIH (NIAID), and HHS (BARDA); he also participated in a 1-day consultation for Allergan, with travel costs paid for by the company. Dr. Mower reports research grants from Allergan, the CDC, and the Patient Centered Outcomes Research Institute.
Publisher Copyright:
© 2017 American College of Emergency Physicians
PY - 2018/1
Y1 - 2018/1
N2 - Study objective Two large randomized trials recently demonstrated efficacy of methicillin-resistant Staphylococcus aureus (MRSA)–active antibiotics for drained skin abscesses. We determine whether outcome advantages observed in one trial exist across lesion sizes and among subgroups with and without guideline-recommended antibiotic indications. Methods We conducted a planned subgroup analysis of a double-blind, randomized trial at 5 US emergency departments, demonstrating superiority of trimethoprim-sulfamethoxazole (320/1,600 mg twice daily for 7 days) compared with placebo for patients older than 12 years with a drained skin abscess. We determined between-group differences in rates of clinical (no new antibiotics) and composite cure (no new antibiotics or drainage) through 7 to 14 and 42 to 56 days after treatment among subgroups with and without abscess cavity or erythema diameter greater than or equal to 5 cm, history of MRSA, fever, diabetes, and comorbidities. We also evaluated treatment effect by lesion size and culture result. Results Among 1,057 mostly adult participants, median abscess cavity and erythema diameters were 2.5 cm (range 0.1 to 16.0 cm) and 6.5 cm (range 1.0 to 38.5), respectively; 44.3% grew MRSA. Overall, for trimethoprim-sulfamethoxazole and placebo groups, clinical cure rate at 7 to 14 days was 92.9% and 85.7%; composite cure rate at 7 to 14 days was 86.5% and 74.3%, and at 42 to 56 days, it was 82.4% and 70.2%. For all outcomes, across lesion sizes and among subgroups with and without guideline antibiotic criteria, trimethoprim-sulfamethoxazole was associated with improved outcomes. Treatment effect was greatest with history of MRSA infection, fever, and positive MRSA culture. Conclusion Treatment with trimethoprim-sulfamethoxazole was associated with improved outcomes regardless of lesion size or guideline antibiotic criteria.
AB - Study objective Two large randomized trials recently demonstrated efficacy of methicillin-resistant Staphylococcus aureus (MRSA)–active antibiotics for drained skin abscesses. We determine whether outcome advantages observed in one trial exist across lesion sizes and among subgroups with and without guideline-recommended antibiotic indications. Methods We conducted a planned subgroup analysis of a double-blind, randomized trial at 5 US emergency departments, demonstrating superiority of trimethoprim-sulfamethoxazole (320/1,600 mg twice daily for 7 days) compared with placebo for patients older than 12 years with a drained skin abscess. We determined between-group differences in rates of clinical (no new antibiotics) and composite cure (no new antibiotics or drainage) through 7 to 14 and 42 to 56 days after treatment among subgroups with and without abscess cavity or erythema diameter greater than or equal to 5 cm, history of MRSA, fever, diabetes, and comorbidities. We also evaluated treatment effect by lesion size and culture result. Results Among 1,057 mostly adult participants, median abscess cavity and erythema diameters were 2.5 cm (range 0.1 to 16.0 cm) and 6.5 cm (range 1.0 to 38.5), respectively; 44.3% grew MRSA. Overall, for trimethoprim-sulfamethoxazole and placebo groups, clinical cure rate at 7 to 14 days was 92.9% and 85.7%; composite cure rate at 7 to 14 days was 86.5% and 74.3%, and at 42 to 56 days, it was 82.4% and 70.2%. For all outcomes, across lesion sizes and among subgroups with and without guideline antibiotic criteria, trimethoprim-sulfamethoxazole was associated with improved outcomes. Treatment effect was greatest with history of MRSA infection, fever, and positive MRSA culture. Conclusion Treatment with trimethoprim-sulfamethoxazole was associated with improved outcomes regardless of lesion size or guideline antibiotic criteria.
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U2 - 10.1016/j.annemergmed.2017.07.483
DO - 10.1016/j.annemergmed.2017.07.483
M3 - Article
C2 - 28987525
AN - SCOPUS:85030629085
SN - 0196-0644
VL - 71
SP - 21
EP - 30
JO - Annals of emergency medicine
JF - Annals of emergency medicine
IS - 1
ER -