{"id":4615,"date":"2013-09-13T18:18:58","date_gmt":"2013-09-13T22:18:58","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=4615"},"modified":"2015-06-04T14:33:05","modified_gmt":"2015-06-04T18:33:05","slug":"clindamycin-vs-tmpsmx-for-soft-tissue-infections-a-clinical-trial-that-needs-some-marketing","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/clindamycin-vs-tmpsmx-for-soft-tissue-infections-a-clinical-trial-that-needs-some-marketing\/2013\/09\/13\/","title":{"rendered":"Clindamycin vs. TMP\/SMX for Soft Tissue Infections: A Clinical Trial That Needs Some Marketing"},"content":{"rendered":"

\"What<\/a>At ICAAC <\/a>this week — the ID conference with the most inscrutable acronym out there — Loren Miller from UCLA presented a clinical trial<\/a>\u00a0on treatment of skin and soft tissue infections that has widespread clinical applications, yet may receive little if any attention.<\/p>\n

And why is that?<\/p>\n

Simply because the drugs (clindamycin and trimethoprim\/sulfamethoxazole) have been off-patent for years. Cripes, they’re so cheap that some pharmacies give them away. That’s right — they’re free!<\/a><\/p>\n

So allow me to market the study a bit.<\/p>\n

Here’s the clinical question:<\/p>\n

Which is better for uncomplicated skin and soft tissue infections — clindamycin or TMP\/SMX?<\/strong><\/p>\n

Clearly the best way to get the answer is to do a randomized, double-blind trial, which is what we have here: Eligible subjects had a skin infection (abscess and\/or cellulitis), were not systemically ill, diabetic, or needing hospitalization. If abscesses were present, they were drained.<\/p>\n

Participants were then randomized to clindamycin 300 mg three-times daily or TMP\/SMX 1 DS tablet twice daily for 10 days, along with matching placebos. \u00a0(Note: \u00a0Meets length of therapy rules<\/a>.)<\/em><\/p>\n

524 study subjects enrolled at 4 US sites; they had a mean age of 27, with 30% younger than 13. 45% had purulent drainage, and virtually all had I and D as part of their management; the remainder had cellulitis alone. Among those who had cultures, more than half had MRSA; 14% of the Staph aureus<\/em> isolates had resistance to clindamycin.<\/p>\n

14 days after enrollment, 80% of the clinda and 78% of the TMP\/SMX group were cured. (About half of the “failures” were really loss to follow-up.) Diarrhea was more common in the clindamycin arm; there were no cases of C diff<\/em>, and no severe rashes to TMP\/SMX.<\/p>\n

So to conclude, they’re basically the same.<\/p>\n

How to choose?\u00a0Here are some pros and cons.<\/p>\n