Empiric Antimicrobial Therapy for Pediatric Skin and Soft-Tissue Infections in the Era of Methicillin-Resistant <i>Staphylococcus aureus</i>

Elliott, Daniel; Zaoutis, Theoklis E.; Troxel, Andrea B.; Loh, Andrew; Keren, Ron

doi:10.1542/peds.2008-2428

Cited by 75 publications

(54 citation statements)

References 22 publications

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“…[8][9][10][11][12] However, a paucity of comparative studies of antimicrobial treatment, 13,14 as well as studies that suggest that antimicrobial therapy may be unnecessary for drained abscesses, [15][16][17] make treatment decisions difficult. In addition, although studies estimated that nearly one-third of MRSA SSTIs result in Ն1 recurrent event, 9,18-20 few studies have attempted to determine the influence of antimicrobial treatment on recurrence risk for pediatric SSTIs.…”

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Comparative Effectiveness of Antibiotic Treatment Strategies for Pediatric Skin and Soft-Tissue Infections

et al. 2011

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WHAT'S KNOWN ON THIS SUBJECT:The burden of pediatric skin and soft-tissue infections (SSTIs) is increasing, largely as a result of the widespread community emergence of methicillin-resistant Staphylococcus aureus (MRSA). Optimal antimicrobial management strategies for SSTIs in the era of communityassociated MRSA remain unclear. WHAT THIS STUDY ADDS:These findings, from a cohort of nearly 50 000 children with incident SSTIs, bring into question the use of trimethoprim-sulfamethoxazole for treatment of purulent SSTIs in community-associated MRSA-prevalent regions in which clindamycin resistance remains low. ␤-Lactams, however, may still be effective for nonpurulent SSTIs. abstract OBJECTIVE: To compare the effectiveness of clindamycin, trimethoprimsulfamethoxazole, and ␤-lactams for the treatment of pediatric skin and soft-tissue infections (SSTIs). METHODS: A retrospective cohort of children 0 to 17 years of age who were enrolled in Tennessee Medicaid, experienced an incident SSTI between 2004 and 2007, and received treatment with clindamycin (reference), trimethoprim-sulfamethoxazole, or a ␤-lactam was created. Outcomes included treatment failure and recurrence, defined as an SSTI within 14 days and between 15 and 365 days after the incident SSTI, respectively. Adjusted models stratified according to drainage status were used to estimate the risk of treatment failure and time to recurrence. RESULTS: Among the 6407 children who underwent drainage, there were 568 treatment failures (8.9%) and 994 recurrences (22.8%). The adjusted odds ratios for treatment failure were 1.92 (95% confidence interval [CI]: 1.49 -2.47) for trimethoprim-sulfamethoxazole and 2.23 (95% CI: 1.71-2.90) for ␤-lactams. The adjusted hazard ratios for recurrence were 1.26 (95% CI: 1.06 -1.49) for trimethoprim-sulfamethoxazole and 1.42 (95% CI: 1.19 -1.69) for ␤-lactams. Among the 41 094 children without a drainage procedure, there were 2435 treatment failures (5.9%) and 5436 recurrences (18.2%). The adjusted odds ratios for treatment failure were 1.67 (95% CI: 1.44 -1.95) for trimethoprim-sulfamethoxazole and 1.22 (95% CI: 1.06 -1.41) for ␤-lactams; the adjusted hazard ratios for recurrence were 1.30 (95% CI: 1.18 -1.44) for trimethoprim-sulfamethoxazole and 1.08 (95% CI: 0.99 -1.18) for ␤-lactams. CONCLUSIONS: Compared with clindamycin, use of trimethoprimsulfamethoxazole or ␤-lactams was associated with increased risks of treatment failure and recurrence. Associations were stronger for those with a drainage procedure. Pediatrics 2011;128:e479-e487 AUTHORS:

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Comparative Effectiveness of Antibiotic Treatment Strategies for Pediatric Skin and Soft-Tissue Infections

et al. 2011

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“…Se sugiere cefalosporina de 1 a generación, como la cefalexina (100 mg/kg/día, 4 veces al día) o TMP-SMZ+ amoxicilina. 22,[42][43][44][45] Para los pacientes que no responden al tratamiento con b-lactámicos, se recomienda la cobertura para el SARM-co con clindamicina. Dosis en pediatría bajo estudio: niños, 5 mg/kg (12-17 años), 7 mg/kg (7-11 años), 9 mg/kg (2-6 años).…”

Section: Sociedad Argentina De Pediatría Subcomisiones Comités Y Gruunclassified

“…Se recomienda la incisión y el drenaje de la lesión junto con la administración de un antibiótico: clindamicina, vancomicina, linezolid o daptomicina. 22,42,43,45 La clindamicina sigue siendo una excelente elección, dado que el nivel de resistencia de los SAMR-co a este antibiótico reportado ha sido menor del 10-15%. Siempre que se detecte resistencia a eritromicina en el antibiograma por difusión en disco, deberá realizarse la prueba de D-test para evidenciar resistencia inducible -macrólidos-lincosamina y estreptogramíneas (MLS)-a clindamicina; en el caso de que la prueba sea positiva, no podrá utilizarse este antibiótico.…”

Section: Sociedad Argentina De Pediatría Subcomisiones Comités Y Gruunclassified

“…Se requieren datos adicionales para definir mejor el papel de los antibióticos en este contexto. [42][43][44] Se sugiere el acompañamiento con antibióticos con cobertura del SAMR-co en aquellos casos graves o extensos o asociados a comorbilidades. 22,25 En las celulitis purulentas sin abscesos drenables, se tendrá en cuenta la cobertura contra el SAMR-co en el tratamiento empírico inicial con antibióticos, como clindamicina, TMP-SMZ, minociclina, doxiciclina, linezolid.…”

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Infecciones de piel y partes blandas en pediatría: consenso sobre diagnóstico y tratamiento

Moyano¹,

Peuchot²,

Giachetti³

et al. 2014

Arch Argent Pediat

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“…Kotrimaksazol A grubu β-hemolitik streptokokların etkeni olduğu infeksiyonlarda yetersiz olduğundan, kültür ve antibiyotik duyarlılığı görülmeden ampirik olarak başlanmamalıdır. Şiddetli MRSA infeksiyonlarında ise intravenöz vankomisin esas seçenektir 10,27,28 . Çocuklarda sık görülen bakteriyel deri infeksiyonlarının tedavi seçenekleri Tablo 2'de özetlenmiştir.…”

Section: Antimikrobiyal Tedavi Ve Direnç Sorunuunclassified

Common Bacterial Skin Infections in Children

Yaylı¹

2011

Turkderm

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ÖzetBakteriyel deri infeksiyonları, çocukluk çağında hastane başvurularının başlıca sebeplerindendir. Hafif şiddette yüzeyel folikülitlerden, hastane yatışı gerektiren stafilokoksik haşlamış deri sendromu gibi komplike infeksiyonlara kadar geniş bir grup hastalığı içerir. Bu infeksiyonlara en sık neden olan patojenler stafilokok ve streptokoklardır. Bakterilerin genel olarak antimikrobiyal direncindeki artış, deri infeksiyonlarının tedavisini zorlaştırmaktadır. Bu nedenle, klinik görünümüyle hafif şiddette olarak değerlendirilen infeksiyonların tedavisi bile önem taşımaktadır. Sum maryBacterial skin infections are among the major reasons for visits to outpatient clinics in childhood period. They contain a large group diseases from mild superficial folliculitis to complicated infections requiring hospitalization, such as staphylococcal scalded skin syndrome. The main pathogens that involved in these infections are staphylococcus and streptococci. The overall increase in antimicrobial resistance of bacteria makes it difficult to treat skin infections. Therefore, it is crucial even treatment of the infections considered as mild infection according to the clinical apearance. Gi riflDermatoloji ve pediatri polikliniklerinde en sık görülen hastalık gruplarından birisi de bakteriyel deri infeksiyonlarıdır. Bakteriyel mikroorganizmalar; impetigo, folikülit, fronkül gibi görece hafif tablolardan, tanısal zorluklar yaratabilen şiddetli deri infeksiyonlarına kadar çok çeşitli hastalıklar oluşturur. Deri infeksiyonlarına en sık yol açan bakteriler sırasıyla Stafilokokkus aureus ve A grubu β-hemolitik streptokoklardır 1 . Bu makalede çocuklarda sık görülen bakteriyel deri infeksiyonları (Tablo 1), tedavi seçenekleri (Tablo 2) ile birlikte gözden geçirilecektir.

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Empiric Antimicrobial Therapy for Pediatric Skin and Soft-Tissue Infections in the Era of Methicillin-Resistant Staphylococcus aureus

Cited by 75 publications

References 22 publications

Comparative Effectiveness of Antibiotic Treatment Strategies for Pediatric Skin and Soft-Tissue Infections

Comparative Effectiveness of Antibiotic Treatment Strategies for Pediatric Skin and Soft-Tissue Infections

Infecciones de piel y partes blandas en pediatría: consenso sobre diagnóstico y tratamiento

Common Bacterial Skin Infections in Children

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