Title: A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses

Daum, RS et al.


What You Need to Know:

For patients with a small skin abscess, improvements in cure rates were observed when clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) were initiated following incision and drainage compared to treatment with incision and drainage alone.

Trial Design:

  • Double-blind, placebo-controlled, prospective study compared the safety and efficacy of clindamycin and TMP-SMX to placebo in the treatment of skin abscesses <5 cm in diameter in children and adults
  • 786 patients were randomized to receive clindamycin, TMP-SMX, or placebo over 10 days following abscess incision and drainage
  • Primary endpoint: clinical cure (measured 7-10 days after treatment was concluded); intention-to-treat analysis

Key Outcomes:

  • Study participants: 64.2% were adults, 35.8% were children; 57.0% were male; S. aureus was isolated from 67.0% of participants, MRSA was isolated from 49.4% of participants
  • Cure rates (10 days after the end of treatment): similar for patients who received clindamycin and TMP-SMX (83.1% and 81.7%, respectively; P=0.73), which were higher than the cure rate seen for placebo patients (68.9%; P<0.001 for both comparisons)
  • Beneficial effect of clindamycin and TMP-SMX was limited to patients with a S. aureus infection
  • New infections in patients initially cured (measured at a 1-month follow-up): present in 6.8% of clindamycin patients, 13.5% of TMP-SMX patients, and 12.4% of placebo patients (P=0.06)
  • Adverse events: experienced by 21.9% of clindamycin patients, 11.1% of TMP-SMX patients, and 12.5% of placebo patients
  • One TMP-SMX patient experienced a hypersensitivity reaction