In settings where community-acquired MRSA is prevalent, which antibiotic is best for uncomplicated wound infections?

New Study

• A new multicenter, randomized, double-blind trial in 500 patients compared 7 days of clindamycin 300 mg 4 times daily to trimethoprim-sulfamethoxazole (TMP-SMX) 4 single strength tablets twice daily.
• Follow-up was performed on days 3 4 (on therapy), 8 10 (end of therapy), 14 21 (test of cure), and 49 63 (extended-follow-up).

What They Found

• Clinical cure rate was > 90% in both groups in the per-protocol population (p = 0.91), and also similar in the intention to treat populations.
• Cultured bacteria were similar between the two groups:
  • MRSA ~40%
  • MSSA ~25%
  • Coagulase-negative staph ~15%
  • Strep species ~5%

Application to Clinical Practice

1. It seems like either clindamycin or TMP-SMX are appropriate antimicrobial choices in uncomplicated wound infections.
2. In this study, strep species were a minor component of the total cases. TMP-SMX is generally not strong against strep species, while clindamycin has good coverage.
3. Consult your local antibiogram when appropriate. At our institution, clindamycin has poor in vitro susceptibility against MRSA.

References

Talan DA, et al. A randomized trial of clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated wound infection. Clin Infect Dis 2016;62(12):1505-13. [PMID 27025829]

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