Document Detail

Empiric outpatient therapy with trimethoprim-sulfamethoxazole, cephalexin, or clindamycin for cellulitis.
MedLine Citation:
PMID:  20920697     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Limited data exist on optimal empiric oral antibiotic treatment for outpatients with cellulitis in areas with a high prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections. METHODS: We conducted a 3-year retrospective cohort study of outpatients with cellulitis empirically treated at a teaching clinic of a tertiary-care medical center in Hawaii. Patients who received more than 1 oral antibiotic, were hospitalized, or had no follow-up information were excluded. Treatment success rates for empiric therapy were compared among commonly prescribed antibiotics in our clinic: cephalexin, trimethoprim-sulfamethoxazole, and clindamycin. Risk factors for treatment failure were evaluated using multivariate logistic regression analysis. RESULTS: Of 544 patients with cellulitis, 405 met the inclusion criteria. 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%). Compliance and adverse drug reaction rates were not significantly different among patients who received these 3 antibiotics. Factors associated with treatment failure included therapy with an antibiotic that was not active against community-associated MRSA (adjusted odds ratio 4.22; 95% confidence interval, 2.25-7.92; P<.001) and severity of cellulitis (adjusted odds ratio 3.74; 95% confidence interval, 2.06-6.79; P<.001). CONCLUSION: 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.
Thana Khawcharoenporn; Alan Tice
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American journal of medicine     Volume:  123     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-05     Completed Date:  2010-10-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  942-50     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
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MeSH Terms
Aged, 80 and over
Anti-Bacterial Agents / adverse effects,  therapeutic use*
Cellulitis / drug therapy*,  microbiology
Cephalexin / adverse effects,  therapeutic use*
Clindamycin / adverse effects,  therapeutic use*
Logistic Models
Middle Aged
Retrospective Studies
Risk Factors
Treatment Failure
Trimethoprim-Sulfamethoxazole Combination / adverse effects,  therapeutic use*
Young Adult
Reg. No./Substance:
0/Anti-Bacterial Agents; 15686-71-2/Cephalexin; 18323-44-9/Clindamycin; 8064-90-2/Trimethoprim-Sulfamethoxazole Combination

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