Management of Skin and Soft Tissue Infections in
Management of Skin and Soft Tissue Infections in
Management of Skin and Soft Tissue Infections in
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Microbiology <strong>of</strong> Purulent SSTIs<br />
Moran NEJM 2006<br />
Is treatment failure the only<br />
important endpo<strong>in</strong>t? Recurrent SSTI?<br />
• Duong : 10 days<br />
– 9% TMP-SMX vs. 28% placebo , p = .02<br />
• Schmitz: 30 days<br />
– 13% TMP-SMX vs 26% placebo, p= .04<br />
Schmitz G Ann Emerg Med 2010; Duong Ann Emerg Med 2009<br />
% patients cured<br />
Abscesses: Do antibiotics provide<br />
benefit over I&D alone?<br />
100%<br />
80%<br />
60%<br />
40%<br />
20%<br />
0%<br />
p=.25 p=.12 p=.52<br />
Cephalex<strong>in</strong> TMP-SMX TMP-SMX<br />
Rajendran '07 Duong '09 Schmitz '10<br />
Placebo<br />
Antibiotic<br />
1 Rajendran AAC 2007; 2 Schmitz G Ann Emerg Med 2010; 3 Duong Ann Emerg Med 2009<br />
Antibiotic therapy is recommended<br />
for abscesses associated with:<br />
• Severe disease, rapidly progressive with<br />
associated cellulitis or septic phlebitis<br />
• Signs or symptoms <strong>of</strong> systemic illness<br />
• Associated comorbidities, immunosuppressed<br />
• Extremes <strong>of</strong> age<br />
• Difficult to dra<strong>in</strong> area (face, h<strong>and</strong>, genitalia)<br />
• Failure <strong>of</strong> prior I&D<br />
Liu C. Cl<strong>in</strong> Infect Dis. 2011<br />
4/12/2011<br />
2
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