TMP-SMX vs Placebo for Uncomplicated Skin Abscess

Talan DA et al.. “Trimethoprim–Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess”. NEJM. 2016. 374(9):823-832.
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Clinical Question

In settings with MRSA, does Trimethoprim-sulfamethoxazole treatment after Incision and drainage of an abscess result in a greater cure rate?

Conclusion

Trimethoprim–sulfamethoxazole treatment resulted in a higher cure rate among patients with a drained cutaneous abscess than placebo for abscess that are successfully drained.

Major Points

Methicillin-resistant Staphylococcus aureus (MRSA) is a well known cause of many abscesses in the ED being the most common cause of purulent skin and soft-tissue infections.^[1][2][3] Treatment for cutaneous abscesses has been incision and drainage with antibiotics generally reserved for those that also had associated cellulitis. This multicenter, double-blind, randomized Controlled Trial of 5 US EDs with >1200 patients challenges the traditional dogma of no antibiotics for simple small uncomplicated abscesses that can be drained. For abscess of median size, 2.5 x 2.0 x 1.5cm that underwent I&D and co-administration of 5 days of TMP/SMX, cure rates were 80.5% vs 73.6% with placebo and I&D.^[4]

1.  Maligner D et al. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in skin abscesses presenting to the pediatric emergency department. N C Med J. 2008 Sep-Oct;69(5):351-4.

2. Pickett A et al. Changing incidence of methicillin-resistant staphylococcus aureus skin abscesses in a pediatric emergency department. Pediatr Emerg Care. 2009 Dec;25(12):831-4.

3. Bradley W. Frazee et al. High Prevalence of Methicillin-Resistant Staphylococcus aureus in Emergency Department Skin and Soft Tissue Infections https://dx.doi.org/10.1016/j.annemergmed.2004.10.011

4. Talan DA et al.. “Trimethoprim–Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess”. NEJM. 2016. 374(9):823-832. [EBQ:TMP-SMX vs Placebo for Uncomplicated Skin Abscess|Bactrim and I&D NEJM]]