April 1st, 2011

Clindamycin or Cephalexin for (Mostly) MRSA?

Over on the Journal Watch Pediatrics site, there’s a summary of a study that compared clindamycin with cephalexin for purulent skin infections in kids age 6 months to 18 years.  The results?

MRSA and methicillin-susceptible Staphylococcus aureus (MSSA) were isolated from 70% and 19% of children, respectively … The primary outcome — clinical improvement at 48 to 72 hours — was similar in the cephalexin and clindamycin groups (94% and 97%, respectively), as was the secondary outcome — resolution of infection at 7 days (97% and 94%).

Should we be surprised that cephalexin — an antibiotic with notoriously poor systemic absorption — did so well vs. infections that were 70% resistant to the antibiotic?

Not really — after all, if antibiotics were required for skin and soft tissue infections, we would have perished as a species in the many thousands of years before the discovery of penicillin.  Most of the cure comes from the local care, which was done in 97% of patients.

Plus, this study of cephalexin vs placebo in adults found the same exact thing.

Finally, it proves something that Primary Care Providers, Emergency Room Doctors, Surgeons, and Pediatricians have known for some time:  If you want to use a weak antibiotic (i.e., almost a placebo) “just in case,” hardly anything beats our old friend “Keflex.”

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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