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The emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) has made management of skin infections in children more complicated. Investigators randomly assigned 200 children (age range, 6 months to 18 years) with uncomplicated purulent skin or soft-tissue infections (abscess, furuncle, or carbuncle) to receive cephalexin or clindamycin for 7 days.
MRSA and methicillin-susceptible Staphylococcus aureus (MSSA) were isolated from 70% and 19% of children, respectively. Management included incision and drainage (in 64% of cases) and expression of pus without incision and drainage (in 33%). The primary outcome — clinical improvement at 48 to 72 hours — was similar in the cephalexin and clindamycin groups (94% and 97%, respectively), as was the secondary outcome — resolution of infection at 7 days (97% and 94%). Worsening of MRSA infections was more common in children who received cephalexin than clindamycin (9% and 3%), but this difference was not significant. One patient in each group was hospitalized because of worsening infection. At 3 months, 18% of patients had recurrent skin infections: Risk for recurrence did not differ by study drug or by isolation of MRSA or MSSA from the initial wound.
Chen AE et al. Randomized controlled trial of cephalexin versus clindamycin for uncomplicated pediatric skin infections. Pediatrics 2011 Mar; 127:e573. (http://dx.doi.org/10.1542/peds.2010-2053)
Comment
This study suggests that treatment with cephalexin or clindamycin leads to similar outcomes in children with uncomplicated skin abscesses in communities where MRSA is common. However, other studies tell us that such patients generally don't need antibiotics at all: They can be treated with incision and drainage alone, with close follow-up.