Adolescent/Child Health

Certain antibiotics increase the risk of treatment failure in children with MRSA-related skin and soft-tissue infections

Children continue to be at risk for developing methicillin-resistant Staphylococcus aureus (MRSA) infections of the skin and soft-tissue (SSTIs). These antibiotic-resistant infections have forced clinicians to look for optimal antibiotics to treat them. A recent study of three different antibiotics found that, compared with clindamycin, use of trimethoprim-sulfamethoxazole (TMP-SMX) or β-lactams was linked to increased risks of treatment failure and infection recurrence in MRSA-prevalent communities in which clindamycin resistance remains low. This link was stronger for children who underwent a drainage procedure.
The study included 47,501 children up to 17 years of age being treated for SSTIs from 2004 to 2007. Treatments were as follows: 61.9 percent received a β-lactam, 22.3 percent received TMP-SMX, and 15.7 percent received clindamycin. Duration of treatment was slightly longer (9.7 days) for TMP-SMX compared to 9.4 days for the other two antibiotics. The use of β-lactams declined significantly from 85.1 percent of all prescriptions in 2004 to 43.8 percent by 2007. On the other hand, there was a dramatic increase in the use of TMP-SMX from just 3.9 percent in 2004 to 38.5 percent in 2007. Children undergoing a drainage procedure were more likely to receive either clindamycin or TMP-SMX.
Among the 6,407 who did receive drainage, 8.9 percent experienced a treatment failure and 22.8 percent had a recurrence. β-lactams and TMP-SMX were associated with increased risks for treatment failure and recurrence compared to clindamycin. In the non-drainage group, the recurrence rate was 18.2 percent and the treatment failure rate was 5.9 percent. The authors note, however, that, although β-lactams are no longer recommended when MRSA is a consideration, these agents may still be effective for nonpurulent SSTIs such as uncomplicated cellulitis or impetigo. The study was supported in part by the Agency for Healthcare Research and Quality (HS13833).
See "Comparative effectiveness of antibiotic treatment strategies for pediatric skin and soft-tissue infections," by Derek J. Williams, M.D., M.P.H., William O. Cooper, M.D., M.P.H., Lisa A. Kaitenbach, M.S., and others in Pediatrics 128(3), pp. e479-e487, 2011.

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