Title: Clindamycin vs. Bactrim for Uncomplicated Wound Infection<br/>Author: Bryan Hayes<br/><a href='http://umem.org/profiles/faculty/369/'>[Click to email author]</a><hr/><p>
In settings where community-acquired MRSA is prevalent, which antibiotic is best for uncomplicated wound infections?</p>
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<strong>New Study</strong></p>
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A new multicenter, randomized, double-blind trial in 500 patients compared 7 days of clindamycin 300 mg 4 times daily to trimethoprim-sulfamethoxazole (TMP-SMX) 4 single strength tablets twice daily.</li>
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Follow-up was performed on days 3–4 (on therapy), 8–10 (end of therapy), 14–21 (test of cure), and 49–63 (extended-follow-up).</li>
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<strong>What They Found</strong></p>
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Clinical cure rate was > 90% in both groups in the per-protocol population (p = 0.91), and also similar in the intention to treat populations.</li>
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Cultured bacteria were similar between the two groups:
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MRSA ~40%</li>
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MSSA ~25%</li>
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Coagulase-negative staph ~15%</li>
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Strep species ~5%</li>
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<strong>Application to Clinical Practice</strong></p>
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It seems like either clindamycin or TMP-SMX are appropriate antimicrobial choices in uncomplicated wound infections.</li>
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In this study, strep species were a minor component of the total cases. TMP-SMX is generally not strong against strep species, while clindamycin has good coverage.</li>
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Consult your local antibiogram when appropriate. At our institution, clindamycin has poor in vitro susceptibility against MRSA.</li>
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<fieldset><legend>References</legend>
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Talan DA, et al. A randomized trial of clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated wound infection. <em>Clin Infect Dis</em> 2016;62(12):1505-13. [<a href="https://www.ncbi.nlm.nih.gov/pubmed/27025829">PMID 27025829</a>]</p>
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