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Gregory J Moran - One of the best experts on this subject based on the ideXlab platform.

  • Subgroup Analysis of Antibiotic Treatment for Skin Abscesses
    Annals of Emergency Medicine, 2017
    Co-Authors: David A Talan, Anusha Krishnadasan, Fredrick M Abrahamian, Frank Lovecchio, David J Karras, Mark T Steele, Richard E Rothman, Gregory J Moran, William R Mower
    Abstract:

    Study objective Two large randomized trials recently demonstrated efficacy of methicillin-resistant Staphylococcus aureus (MRSA)–active antibiotics for drained Skin Abscesses. We determine whether outcome advantages observed in one trial exist across lesion sizes and among subgroups with and without guideline-recommended antibiotic indications. Methods We conducted a planned subgroup analysis of a double-blind, randomized trial at 5 US emergency departments, demonstrating superiority of trimethoprim-sulfamethoxazole (320/1,600 mg twice daily for 7 days) compared with placebo for patients older than 12 years with a drained Skin Abscess. We determined between-group differences in rates of clinical (no new antibiotics) and composite cure (no new antibiotics or drainage) through 7 to 14 and 42 to 56 days after treatment among subgroups with and without Abscess cavity or erythema diameter greater than or equal to 5 cm, history of MRSA, fever, diabetes, and comorbidities. We also evaluated treatment effect by lesion size and culture result. Results Among 1,057 mostly adult participants, median Abscess cavity and erythema diameters were 2.5 cm (range 0.1 to 16.0 cm) and 6.5 cm (range 1.0 to 38.5), respectively; 44.3% grew MRSA. Overall, for trimethoprim-sulfamethoxazole and placebo groups, clinical cure rate at 7 to 14 days was 92.9% and 85.7%; composite cure rate at 7 to 14 days was 86.5% and 74.3%, and at 42 to 56 days, it was 82.4% and 70.2%. For all outcomes, across lesion sizes and among subgroups with and without guideline antibiotic criteria, trimethoprim-sulfamethoxazole was associated with improved outcomes. Treatment effect was greatest with history of MRSA infection, fever, and positive MRSA culture. Conclusion Treatment with trimethoprim-sulfamethoxazole was associated with improved outcomes regardless of lesion size or guideline antibiotic criteria.

  • trimethoprim sulfamethoxazole versus placebo for uncomplicated Skin Abscess
    The New England Journal of Medicine, 2016
    Co-Authors: David A Talan, William R Mower, Anusha Krishnadasan, Fredrick M Abrahamian, Frank Lovecchio, David J Karras, Mark T Steele, Richard E Rothman, Rebecca Hoagland, Gregory J Moran
    Abstract:

    BackgroundU.S. emergency department visits for cutaneous Abscess have increased with the emergence of methicillin-resistant Staphylococcus aureus (MRSA). The role of antibiotics for patients with a drained Abscess is unclear. MethodsWe conducted a randomized trial at five U.S. emergency departments to determine whether trimethoprim–sulfamethoxazole (at doses of 320 mg and 1600 mg, respectively, twice daily, for 7 days) would be superior to placebo in outpatients older than 12 years of age who had an uncomplicated Abscess that was being treated with drainage. The primary outcome was clinical cure of the Abscess, assessed 7 to 14 days after the end of the treatment period. ResultsThe median age of the participants was 35 years (range, 14 to 73); 45.3% of the participants had wound cultures that were positive for MRSA. In the modified intention-to-treat population, clinical cure of the Abscess occurred in 507 of 630 participants (80.5%) in the trimethoprim–sulfamethoxazole group versus 454 of 617 participant...

David A Talan - One of the best experts on this subject based on the ideXlab platform.

  • Adjunctive antibiotics for drained Skin Abscesses improve clinical cure rate
    Evidence-based Medicine, 2017
    Co-Authors: David A Talan
    Abstract:

    Commentary on : Daum RS, Miller LG, Immergluck LA, et al . Placebo-controlled trial of antibiotics for smaller Skin Abscesses. N Engl J Med 2017;376:2545–55. The primary treatment of a Skin Abscess is drainage. Past studies of adjunctive antibiotic treatment conducted before and after the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) in the USA and other parts of the world were small and did not clearly demonstrate benefit. In 2016, Talan et al 1 reported a US randomised placebo-controlled trial (RCT) among 1265 mostly adults, including some with co-morbidities, which demonstrated that treatment with an antibiotic possessing in vitro activity against MRSA, trimethoprim–sulfamethoxazole (TMP-SMX), was associated with a significantly higher short-term cure rate among patients with a drained Skin Abscess ≥2 cm in diameter. TMP-SMX-treated participants also had fewer additional drainage procedures and new site Skin infections through 4–6 post-treatment. Overall adverse event rates were similar, with slightly …

  • Subgroup Analysis of Antibiotic Treatment for Skin Abscesses
    Annals of Emergency Medicine, 2017
    Co-Authors: David A Talan, Anusha Krishnadasan, Fredrick M Abrahamian, Frank Lovecchio, David J Karras, Mark T Steele, Richard E Rothman, Gregory J Moran, William R Mower
    Abstract:

    Study objective Two large randomized trials recently demonstrated efficacy of methicillin-resistant Staphylococcus aureus (MRSA)–active antibiotics for drained Skin Abscesses. We determine whether outcome advantages observed in one trial exist across lesion sizes and among subgroups with and without guideline-recommended antibiotic indications. Methods We conducted a planned subgroup analysis of a double-blind, randomized trial at 5 US emergency departments, demonstrating superiority of trimethoprim-sulfamethoxazole (320/1,600 mg twice daily for 7 days) compared with placebo for patients older than 12 years with a drained Skin Abscess. We determined between-group differences in rates of clinical (no new antibiotics) and composite cure (no new antibiotics or drainage) through 7 to 14 and 42 to 56 days after treatment among subgroups with and without Abscess cavity or erythema diameter greater than or equal to 5 cm, history of MRSA, fever, diabetes, and comorbidities. We also evaluated treatment effect by lesion size and culture result. Results Among 1,057 mostly adult participants, median Abscess cavity and erythema diameters were 2.5 cm (range 0.1 to 16.0 cm) and 6.5 cm (range 1.0 to 38.5), respectively; 44.3% grew MRSA. Overall, for trimethoprim-sulfamethoxazole and placebo groups, clinical cure rate at 7 to 14 days was 92.9% and 85.7%; composite cure rate at 7 to 14 days was 86.5% and 74.3%, and at 42 to 56 days, it was 82.4% and 70.2%. For all outcomes, across lesion sizes and among subgroups with and without guideline antibiotic criteria, trimethoprim-sulfamethoxazole was associated with improved outcomes. Treatment effect was greatest with history of MRSA infection, fever, and positive MRSA culture. Conclusion Treatment with trimethoprim-sulfamethoxazole was associated with improved outcomes regardless of lesion size or guideline antibiotic criteria.

  • trimethoprim sulfamethoxazole versus placebo for uncomplicated Skin Abscess
    The New England Journal of Medicine, 2016
    Co-Authors: David A Talan, William R Mower, Anusha Krishnadasan, Fredrick M Abrahamian, Frank Lovecchio, David J Karras, Mark T Steele, Richard E Rothman, Rebecca Hoagland, Gregory J Moran
    Abstract:

    BackgroundU.S. emergency department visits for cutaneous Abscess have increased with the emergence of methicillin-resistant Staphylococcus aureus (MRSA). The role of antibiotics for patients with a drained Abscess is unclear. MethodsWe conducted a randomized trial at five U.S. emergency departments to determine whether trimethoprim–sulfamethoxazole (at doses of 320 mg and 1600 mg, respectively, twice daily, for 7 days) would be superior to placebo in outpatients older than 12 years of age who had an uncomplicated Abscess that was being treated with drainage. The primary outcome was clinical cure of the Abscess, assessed 7 to 14 days after the end of the treatment period. ResultsThe median age of the participants was 35 years (range, 14 to 73); 45.3% of the participants had wound cultures that were positive for MRSA. In the modified intention-to-treat population, clinical cure of the Abscess occurred in 507 of 630 participants (80.5%) in the trimethoprim–sulfamethoxazole group versus 454 of 617 participant...

  • Management of Skin Abscesses in the era of methicillin-resistant Staphylococcus aureus.
    The New England Journal of Medicine, 2014
    Co-Authors: Adam Singer, David A Talan
    Abstract:

    In this article, we describe our approach to the management of common Skin Abscesses that generally involve the extremities and trunk. Lesions that may require unique surgical approaches or that have a more complex microbiologic basis, such as Abscesses in the perineal area, are not addressed. Whenever possible, our recommendations are based on randomized trials. However, many of the recommendations are based on small, observational studies or expert opinion; thus, we recognize that there may be disagreement with some of our recommendations. Nevertheless, the approach we advise has been shown to be workable and useful in our practice. Diagnosis A Skin Abscess results from the accumulation of pus in the dermis or subcutaneous tissue and appears as a swollen, red, tender, and fluctuant mass, often with surrounding cellulitis. Diagnosis of a Skin Abscess based on physical examination is often straightforward and proved correct by incision and drainage. However, Abscesses that extend deeper into the dermis and subcutaneous tissue, especially those associated with extensive cellulitis, may be more difficult to diagnose because overlying tissue induration may prevent fluctuance from being observed. Physicians’ clinical assessments during physical examination also vary. In one study, involving 349 children presenting to a hospital with Skin and soft-tissue infections, interobserver agreement among pediatric attending physicians and fellows regarding the presence of an Abscess was only fair and was not associated with the extent of the physician’s experience. 14

Myto Duong - One of the best experts on this subject based on the ideXlab platform.

  • randomized controlled trial of antibiotics in the management of community acquired Skin Abscesses in the pediatric patient
    Annals of Emergency Medicine, 2010
    Co-Authors: Myto Duong, Stephen Markwell, John Peter, Stephen J Barenkamp
    Abstract:

    Study objective Emergency department visits for Skin and soft tissue infections are increasing with the discovery of community-acquired methicillin-resistant Staphylococcus aureus . Whether Abscesses treated surgically also require antibiotics is controversial. There are no published pediatric randomized controlled trials evaluating the need for antibiotics in Skin Abscess management. We determine the benefits of antibiotics in surgically managed pediatric Skin Abscesses. Methods This was a double-blind, randomized, controlled trial. Pediatric patients were randomized to receive 10 days of placebo or trimethoprim-sulfamethoxazole after incision and draining. Follow-up consisted of a visit/call at 10 to 14 days and a call at 90 days. Primary outcome was treatment failure at the 10-day follow-up. Secondary outcome was new lesion development at the 10- and 90-day follow-ups. Noninferiority of placebo relative to trimethoprim-sulfamethoxazole for primary and secondary outcomes was assessed. Results One hundred sixty-one patients were enrolled, with 12 lost to follow-up. The failure rates were 5.3% (n=4/76) and 4.1% (n=3/73) in the placebo and antibiotic groups, respectively, yielding a difference of 1.2%, with a 1-sided 95% confidence interval (CI) (−∞ to 6.8%). Noninferiority was established with an equivalence threshold of 7%. New lesions occurred at the 10-day follow-up: 19 on placebo (26.4%) and 9 on antibiotics (12.9%), yielding a difference of 13.5%, with 95% 1-sided CI (−∞ to 24.3%). At the 3-month follow-up, 15 of 52 (28.8%) in the placebo group and 13 of 46 (28.3%) in the antibiotic group developed new lesions. The difference was 0.5%, with 95% 1-sided CI (−∞ to 15.6%). Conclusion Antibiotics are not required for pediatric Skin Abscess resolution. Antibiotics may help prevent new lesions in the short term, but further studies are required.

  • Skin Abscess model for incision and drainage
    Academic Emergency Medicine, 2009
    Co-Authors: Myto Duong, Jennifer Bartlett, Regina Kovach
    Abstract:

    Background: Skin and soft tissue infection diagnosis is increasing dramatically across the nation. All healthcare providers need to be trained in adequate incision and drainage of these lesions. The only descriptions of Skin and soft tissue models in the literature involve the use of cadavers or chickens. We devised an inexpensive and easily assembled Skin Abscess model that will be invaluable for the training of this procedure for all healthcare providers. This relatively realistic Skin Abscess model can be assembled within minutes using materials that can be purchased in your local grocery or home improvement store. The steps required in the creation of this Abscess model will be depicted in the exhibit. Supplies for assembly of the model will be available during the exhibition for participants to build their own Abscess and practice incising and draining their Abscess. Materials: ? Lotion (white) mixed with food coloring (red, blue, yellow) ? Baby oil gel ? 1” Urethane Foam sheeting ? Heavy cardboard or poster board ? Food handler gloves (Textra Cast Poly) ? Glue gun (low temp) ? Low temp glue gun sticks ?“Smooth Top® Easy Liner®” shelf liner ? Abscess incision and drainage kit. Conclusion: This exhibit will provide a detailed description of how to assemble a quick and easy Skin Abscess model for incision and drainage. This model can be used in the skills lab to demonstrate and practice this basic procedure.

Koko Aung - One of the best experts on this subject based on the ideXlab platform.

Daniel J Pallin - One of the best experts on this subject based on the ideXlab platform.

  • clinical trial comparative effectiveness of cephalexin plus trimethoprim sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis a randomized controlled trial
    Clinical Infectious Diseases, 2013
    Co-Authors: Daniel J Pallin, William Binder, Matthew B Allen, Molly Lederman, Siddharth Parmar, Michael R Filbin, David C Hooper, Carlos A Camargo
    Abstract:

    Background. Community-associated methicillin-resistant S. aureus (CA-MRSA) is the most common organism isolated from purulent Skin infections. Antibiotics are usually not beneficial for Skin Abscess, and national guidelines do not recommend CA-MRSA coverage for cellulitis, except purulent cellulitis, which is uncommon. Despite this, antibiotics targeting CA-MRSA are prescribed commonly and increasingly for Skin infections, perhaps due, in part, to lack of experimental evidence among cellulitis patients. We test the hypothesis that antibiotics targeting CAMRSA are beneficial in the treatment of cellulitis. Methods. We performed a randomized, multicenter, double-blind, placebo-controlled trial from 2007 to 2011. We enrolled patients with cellulitis, no Abscesses, symptoms for <1 week, and no diabetes, immunosuppression, peripheral vascular disease, or hospitalization (clinicaltrials.gov NCT00676130). All participants received cephalexin. Additionally, each was randomized to trimethoprim-sulfamethoxazole or placebo. We provided 14 days of antibiotics and instructed participants to continue therapy for ≥1 week, then stop 3 days after they felt the infection to be cured. Our main outcome measure was the risk difference for treatment success, determined in person at 2 weeks, with telephone and medical record confirmation at 1 month. Results. We enrolled 153 participants, and 146 had outcome data for intent-to-treat analysis. Median age was 29, range 3–74. Of intervention participants, 62/73 (85%) were cured versus 60/73 controls (82%), a risk difference of 2.7% (95% confidence interval, −9.3% to 15%; P= .66). No covariates predicted treatment response, including nasal MRSA colonization and purulence at enrollment. Conclusions. Among patients diagnosed with cellulitis without Abscess, the addition of trimethoprim-sulfamethoxazole to cephalexin did not improve outcomes overall or by subgroup. Clinical Trials Registration. NCT00676130.