Clindamycin versus Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Infections

Mi Jin Kim, Mercer University College of Pharmacy 2015

According to Centers for Disease Control and Prevention (CDC), the number of skin infections is increasing in ambulatory care.1 Infectious Diseases Society of America (IDSA) suggests that clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX) are options for treating skin infections.2 A recently published study compared clindamycin and TMP-SMX for the treatment of uncomplicated skin infections.

Title: Clindamycin versus Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Infections
Design Multicenter, prospective, randomized, double-blind study; 524 patients
Objective

(Primary)

To compare clindamycin and Trimethoprim-Sulfamethoxazole (TMP-SMX) for the treatment of uncomplicated skin infections
Study Groups Clindamycin group (n= 264 patients) vs. TMP-SMX group (n= 260 patients)
Methods Patients randomly received clindamycin or TMP-SMX in a 1:1 ratio for 10 days. Clindamycin was given as two 150 mg tablets three times daily while TMX-SMX was given as two tablets twice daily at doses of 160 mg of trimethoprim and 800 mg of sulfamethoxazole. Two placebo pills for the midday dose were given patients who received TMP-SMX .
Duration From May 2009 through August 2011
Primary outcome measure Clinical cure 7 to 10 days after the end of treatment
Baseline Characteristics Clindamycin group: female 48.9%, white 38.6%, age (>18) 69.3%

TMP-SMX group: female 46.5%, white 41.9%, age (>18) 71.5%

Results The proportion of patients cured was 80.3% in the clindamycin group and 77.7% in the TMP-SMX group. (95% confidence interval [CI] -10.2 to 4.9; p=0.52)
Adverse Events Common Adverse Effects:

Clindamycin: diarrhea 9.7%, nausea 2.3%, vomiting 2.3%, pruritus 1.5%, rash 1.2%

TMP-SMX: diarrhea 10.1%, nausea 2.7%, vomiting 1.6%, pruritus 1.2%, rash 0.8%

Serious Adverse Events: None
Percentage that Discontinued due to Adverse Events:

Clindamycin 8.3%

TMP-SMX: 8.8%

Study Author Conclusions We found no significant difference between clindamycin TMP-SMX, with respect to either efficacy or side effect profile, for the treatment of uncomplicated skin infections, including both cellulitis and abscesses.

This study was a double-blind, randomized clinical trial comparing clindamycin and TMP-SMX, which are commonly recommended agents as empirical therapy for uncomplicated skin infections in the outpatient population. The trial investigated outpatients, including both adults and children. This inclusion criterion is one of strengths of this study because these skin infections are highly prevalent among people of all ages. The populations studied were also ethnically and geographically diverse. The results of this study did not show superiority of either intervention.

References:

  1. Centers for Disease Control and Prevention. http://wwwnc.cdc.gov/eid/article/12/11/pdfs/06-0190. Accessed April 1, 2015.
  2. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis. 2014;59(2):147-59.
  3. Miller LG, Daum RS, Creech CB, et al. Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections. N Engl J Med. 2015; 372(12): 1093-103.
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