A recent study conducted by researchers at the Department of Pediatrics and Pathology of Hopkins Hospital and the Department of Biostatistics at the Bloomberg School of Public Health compared the efficiency of two different drugs, clindamycin and cephalexin, in treating antibiotic resistant skin infections.
Since the mid-1990s, an epidemic of skin infections among the healthy community has continued to surface in non-hospitalized children in the United States and throughout the world.
The most common skin infection is called community-asociated methicillin-resistant Staphylococcus aureus (CA-MRSA). CA-MRSA can cause a variety of skin conditions, ranging from purulent skin to sepsis and necrotizing pnemonia.
CA-MRSA causes the majority of purulent skin infections, which are medically referred to as skin and soft tissue infections (SSTIs) in children.
It is spread through skin to skin contact and is common among children because they spend much of their time in crowded places such as schools and day care centers.
SSTIs are usually treated with antibiotics that can vary depending on the clinician. However, the effectiveness and success rate of other forms of treatment for SSTIs such as incision and drainage (ID) remain unclear.
Furthermore, no trials have been done to compare antibiotics that provide treatment for all staphylococcal bacteria, of which MRSA constitutes a specific class, with antibiotics that are specific to MRSA, also called MRSA-active adjuvant antibiotics.
Cephalexin, one of the drugs involved in the study, is an antibiotic that specifically targets MRSA.
Researchers wanted to compare the efficiency of cephalexin in treating MRSAs to that of clindamycin, a general antibiotic that does not specifically target MRSAs.
The group of scientists carrying out this study hypothesized that the antibiotic clindamycin would be superior to the antibiotic cephalexin.
Outcomes were measured two to three days and one week after initiating treatment. Patient outcomes were scored based on several parameters including persistence of fever, erythema, drainage, pain and tenderness.
Pediatric patients ranging in age from 6 months to 18 years with SSTIs were recruited into the study from September 2006 to May 2009.
Results showed that there was no significant difference in treatment between cephalexin and clindamycin for pediatric SSTI patients caused predominantly by CA-MRSA, the most common strand of the bacteria found in children.
Close follow-up and meticulous wound care of appropriate drained, uncomplicated SSTIs were deemed as more important procedures than initial antibiotic choice.
“The good news is that no matter which antibiotic we gave, nearly all skin infections cleared up fully within a week. The better news might be that good low-tech wound care, cleaning, draining and keeping the infected area clean, is what truly makes the difference between rapid healing and persistent infection,” said study lead investigator Aaron Chen, an emergency physician at Hopkins Children’s Hospital, in a report for Science Daily.
Despite these findings, many clinicians admit to feeling discomfort when withholding antibiotics from patients suffering from purulent SSTIs, even if they have been treated with ID. Most clinicians would still prescribe an oral antibiotic in conjunction with ID treatment to patients suffering from SSTIs.
“Many physicians understandably assume that antibiotics are always necessary for bacterial infections, but there is evidence to suggest this may not be the case,” said senior investigator George Siberry, a Hopkins Children’s pediatrician and medical officer at the Eunice Kennedy Shriver Institute of Child Health & Human Development.
“We need studies that precisely measure the benefit of antibiotics to help us determine which cases warrant them and which ones would fare well without them.”
