1. Clindamycin vs TMP-SMX for Uncomplicated Skin Infections
Loren G. Miller, M.D., M.P.H., Robert S. Daum, M.D., C.M., C. Buddy Creech, M.D., M.P.H., David Young, M.D., Michele D. Downing, R.N., M.S.N., Samantha J. Eells, M.P.H., Stephanie Pettibone, B.S., Rebecca J. Hoagland, M.S., and Henry F. Chambers, M.D.
Michael Modica, PGY-I
April 23, 2015

2. Objective
To compare clindamycin and TMP-SMX for the treatment of uncomplicated skin infections at four U.S. centers located in areas of community associated MRSA endemicity.

3. Background
Skin and skin-structure infections are common in ambulatory settings. However, the efficacy of various antibiotic regimens in the era of community-acquired methicillin resistant Staphylococcus aureus (MRSA) is unclear.

4. Population All greater than 6 months of age
Excluded infections in sites requiring specialty care, high fever, immunocompromising comorbid conditions, human or animal bite, morbid obesity
Sites in Chicago, Los Angeles, San Francisco, Nashville
Separated into limited abscess vs larger abscess-cellulitis groups
Abscess >5cm in largest dimension
Only larger abscess-cellulitis group reported

5. Study Design All abscesses drained prior to antibiotic therapy
Separated into two groups
Clindamycin 300mg TID
TMP-SMX mg BID (placebo as third dose)
Both groups completed ten days of therapy
Follow up at completion of therapy, 7 to 10 days after completion of therapy, and 1 month after therapy

6. Effectiveness of Clindamycin vs TMP-SMX at Time-of-Cure Visit

7. Culture Data 43.5% of patients had no culture obtained
217/277 positive cultures were staph aureus
167 MRSA
52 MSSA
Of 217 with staph aureus
27 clindamycin resistant strains (5.2%)
1 TMP-SMX resistant strain (0.2%)

8. Side Effect Profile Clindamycin TMP-SMX Diarrhea 9.7% 10.1%
Nausea % %
Vomiting % %
Pruritis % %
Rash % %
C. Diff colitis
Treatment Stopped % %

9. Conclusion
No significant difference in either cure rate or side effect profile between clindamycin and TMP-SMX

10. Study Strengths and Weaknesses
Outpatient setting (>95% of cellulitis cases)
Extended follow up to one month
Weaknesses
Patients with comorbidities excluded
Limited abscess group not reported

11. Clindamycin vs TMP-SMX
Clindamycin - $47.64 for twenty 300mg tablets
10 day course (30 tablets) - $71.46
Bactrim - $53.29 for sixty mg tablets
10 day course (20 tablets) - $35.70
Prices via Epocrates and

12. Questions?