Randomized, Controlled Trial of Antibiotics in the Management of Community-Acquired Skin Abscesses in the Pediatric Patient

Duong, Myto; Markwell, Stephen; Peter, John R.; Barenkamp, Stephen J.

doi:10.1016/j.annemergmed.2009.03.014

Cited by 187 publications

(155 citation statements)

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“…Comentario: el TMP/SMX es un tratamiento eficaz para un gran número de infecciones, especialmente de los tractos respiratorio y urinario, por lo que es importante tener en cuenta que con su uso indiscriminado se puede inducir resistencia especialmente en cepas de Escherichia coli y Streptococcus pneumoniae, de las que se sabe que al menos 30 % son resistentes (8,10). Aunque se considere un tratamiento económico, ampliamente disponible y efectivo, no es inocuo para los pacientes debido a que se puede asociar con complicaciones graves como colitis por Clostridium difficile, alteraciones renales y electrolíticas, interacciones medicamentosas y reacciones cutáneas graves como el síndrome de Stevens-Johnson (9,11).…”

Section: Asignación: Aleatoriaunclassified

Ronda clínica y epidemiológica: club de revistas

Restrepo-Álvarez

Galeano-Toro

Hincapié-Osorno

et al. 2017

iatreia

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RESUMENEn esta edición de la Ronda Clínica y Epidemiológica analizamos cuatro artículos que consideramos importantes para la práctica clínica. El estudio del grupo SPIROMICS busca replantear la necesidad de la espirometría para el diagnóstico de enfermedad pulmonar obstructiva crónica (EPOC), especialmente en los pacientes con antecedente de tabaquismo que tienen función pulmonar normal, pero desarrollan desenlaces de enfermedad pulmonar crónica. Borja-Gómez y colaboradores, por otro lado, validan un enfoque sistemático para descartar infecciones bacterianas invasivas en niños febriles menores de 3 meses. El estudio de Talan y colaboradores estima la utilidad del tratamiento antibiótico con trimetoprim-sulfametoxazol, adicional al drenaje quirúrgico, como una estrategia para mejorar la curación de abscesos en piel en una población con alta prevalencia de Staphylococcus aureus resistente a meticilina (MRSA). Por último, el estudio del grupo EAT que analiza la introducción de alimentos alergénicos en lactantes a partir de los 3 meses, como una estrategia para proteger contra el desarrollo de reacciones alérgicas alimentarias posteriores.

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Section: Asignación: Aleatoriaunclassified

Ronda clínica y epidemiológica: club de revistas

Restrepo-Álvarez

Galeano-Toro

Hincapié-Osorno

et al. 2017

iatreia

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“…Publications of uSSTI studies were excluded for one of the following criteria: placebo add-on treatment, pediatric exclusivity, prevention or colonization trials, or inclusion of subjects with minor cutaneous abscesses treated via incision and drainage as surgical treatment. The latter group was excluded as any potential estimate of placebo effect could not be assessed independently of the surgical treatment effect (25)(26)(27).…”

Section: Methodsmentioning

confidence: 99%

Systematic Review and Meta-Analysis To Estimate Antibacterial Treatment Effect in Acute Bacterial Skin and Skin Structure Infection

Cates

Mitrani-Gold

et al. 2015

Antimicrob Agents Chemother

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A systematic literature review and meta-analysis were conducted to estimate the antibacterial treatment effect for linezolid and ceftaroline to inform on the design of acute bacterial skin and skin structure infection (ABSSSI) noninferiority trials. The primary endpoints included an early clinical treatment response (ECTR) defined as cessation of lesion spread at 48 to 72 h postrandomization and the test-of-cure (TOC) response defined as total resolution of the infection at 7 to 14 days posttreatment. The systematic review identified no placebo-controlled trials in ABSSSI, 4 placebo-controlled trials in uncomplicated skin and soft tissue infection as a proxy for placebo in ABSSSI, 12 linezolid trials in ABSSSI, 3 ceftaroline trials in ABSSSI, and 2 trials for nonantibacterial treatment. The ECTR rates at 48 to 72 h and corresponding 95% confidence intervals (CI) were 78.7% (95% CI, 61.1 to 96.3%) for linezolid, 74.0% (95% CI, 69.7 to 78.3%) for ceftaroline, and 59.0% (95% CI, 52.8 to 65.3%) for nonantibacterial treatment. The early clinical treatment effect could not be estimated, given no available placebo or proxy for placebo data for this endpoint. Clinical, methodological, and statistical heterogeneity influenced the selection of trials for the meta-analysis of the TOC treatment effect estimation. The pooled estimates of the TOC treatment response were 31.0% (95% CI, 6.2 to 55.9%) for the proxy for placebo, 88.1% (95% CI, 81.0 to 95.1%) for linezolid, and 86.1% (95% CI, 83.7 to 88.6%) for ceftaroline. The TOC clinical treatment effect estimation was 25.1% for linezolid and 27.8% for ceftaroline. The antibacterial treatment effect estimation at TOC will inform on the design and analysis of future noninferiority ABSSSI clinical trials. Over the past decade, robust clinical, scientific, and regulatory debate has emerged for initiatives to improve the design, execution, and analysis of antibacterial clinical trials (1-4). New trials for acute bacterial skin and skin structure infections (ABSSSI), previously referred to as complicated skin and skin structure infections (cSSTI), remain important, given the rise in incidence of methicillin-resistant Staphylococcus aureus infections and reports of treatment failure (5-8). Per guidance from the U.S. Food and Drug Administration (FDA), patient eligibility for enrollment in ABSSSI trials should be restricted to those with erysipelas, cellulitis, major cutaneous abscesses, and wound infections having a minimal lesion surface area involvement of 75 cm 2 (9). For trial endpoints, the traditional test-of-cure (TOC) endpoint, with the treatment success defined as total resolution of the infection at 7 to 14 days posttreatment, remains aligned with the European regulatory guidance, yet the treatment success for the primary efficacy endpoint aligned with the FDA guidance is defined as cessation of lesion spread after 48 to 72 h of treatment (9-11). Revisions to the enrollment and endpoint criteria in recent regulatory guidance for ABSSSI trials necessitate reevaluation of the...

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“…Incision and drainage of a simple, cutaneous abscess should serve as the primary treatment and adjunctive antimicrobial therapy is often not indicated. 14,20,21 Bacterial culture and antimicrobial susceptibilities should be obtained when drainage is performed on recurrent or persistent abscesses to aid in guiding antimicrobial therapy if indicated. 22 Due to the retrospective nature of this study, specific reasons for selecting TMP-SMX to treat an SSTI or other infection are unclear; however, the general overuse of antibiotics in children is well described.…”

Section: Figurementioning

confidence: 99%

Trends in Adverse Reactions to Trimethoprim-Sulfamethoxazole

2012

PEDIATRICS

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Randomized, Controlled Trial of Antibiotics in the Management of Community-Acquired Skin Abscesses in the Pediatric Patient

Cited by 187 publications

References 11 publications

Ronda clínica y epidemiológica: club de revistas

Ronda clínica y epidemiológica: club de revistas

Systematic Review and Meta-Analysis To Estimate Antibacterial Treatment Effect in Acute Bacterial Skin and Skin Structure Infection

Trends in Adverse Reactions to Trimethoprim-Sulfamethoxazole

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