Cephalexin and clindamycin have comparable effectiveness for the treatment of uncomplicated pediatric skin and soft tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus, findings from a randomized double-blind study of 200 patients suggest.
Clinical improvement occurred by 48-72 hours in 94% of 100 patients randomized to receive treatment with 40 mg/kg per day of cephalexin taken orally in divided doses administered 3 times per day – a traditional antistaphylococcal antibiotic without activity against methicillin-resistant S. aureus (MRSA), and in 97% of 100 patients randomized to receive treatment with 20 mg/kg per day of clindamycin taken orally in divided doses administered 3 times per day – an antibiotic with high clinical activity against community-acquired MRSA (CA-MRSA). By 7 days, all subjects in both groups were improved, with complete resolution in 97% and 94% of patients in the cephalexin and clindamycin groups, respectively, Dr. Aaron E. Chen of Johns Hopkins Medical Institutions, Baltimore, and his colleagues reported in the March issue of Pediatrics.
The response rates in the groups did not differ significantly, but fever and age of less than 1 year were significantly associated with a lower rate of resolution at 48-72 hours. Only fever at baseline was associated with a significantly lower rate of resolution at 7 days, the investigators wrote (Pediatrics 2011;127:e573-80).
Patients in the study were children aged 6 months to 18 years who presented from September 2006 through May 2009 with uncomplicated skin and soft tissue infections (SSTI) not requiring hospitalization. MRSA was cultured from wounds in 69% of participants, and the isolates had characteristics consistent with community-acquired infection, the investigators noted.
Neither demographic variables nor characteristics of infection at baseline differed significantly between the two groups.
Unless additional studies confirm previous reports that adjuvant antibiotics offer no benefit for the treatment of uncomplicated, purulent SSTIs in children, the current findings suggest that cephalexin is "a viable empiric antibiotic choice (even in areas with a high prevalence of CA-MRSA) in the context of management that already includes careful drainage of purulent collections, attention to wound care, and appropriate follow-up, especially in children of younger age and with fever," Dr. Chen and his associates wrote.
The findings are important because clindamycin is frequently used for the treatment of uncomplicated SSTIs. At Johns Hopkins, for instance, it has been standard practice since mid-2004 to use clindamycin for this purpose – a decision based on "reports of safety and efficacy in children with MRSA infections and the perceived importance of antibiotics in the management of SSTIs," the investigators wrote.
This has resulted in significantly increased use of clindamycin despite its numerous disadvantages over traditional antistaphylococcal antibiotics, including higher cost, poor palatability, greater concern regarding adverse effects, and development of antibiotic resistance, they added.
Dr. Chen and his associates reported having no relevant financial disclosures. This study was funded in part by the National Institutes of Health.