Commonly prescribed antibiotic may not work best against MRSA skin infections in children
Kelly Ivey, 15, a 10th grader at Hillwood High School, Nashville, Tenn., is having his IV checked by nurse Kellyn Hickey, RN at the Monroe Carell Jr. Children's Hospital at Vanderbilt. Ivey was in the hospital’s Pediatric Emergency Department receiving clindamycin for an MRSA boil. Typically, multiple patient are seen every day with the skin infection. Credit: Steve Green/Vanderbilt photography
In the battle against community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections, many doctors offices may be choosing incorrectly when selecting oral antibiotics to treat children.
A large study conducted by Vanderbilt University Medical Center researchers, published in this weeks edition of the journal Pediatrics, demonstrates a dramatic increase in the use of trimethoprim-sulfamethoxazole or TMP-SMX (Bactrim) to counter the explosion of CA-MRSA skin boils in children across Tennessee. But another drug clindamycin -- may work better.
These data are very revealing as to what is happening out in the trenches that Bactrim is not as effective as clindamycin in either treating the initial infection (of skin boils) or preventing repeat infections over the next year, said the studys senior author, Buddy Creech, M.D., MPH, assistant professor of Pediatric Infectious Diseases.
CA-MRSA (commonly pronounced as MUR-suh) is a bacterium responsible for several difficult-to-treat skin infections that have become more prevalent in recent years, causing outbreaks of infections among children and adults in close communal settings.
The retrospective study examined TennCare records for some 50,000 Tennessee children to compare outcomes of three drugs: beta-lactams (penicillin-based medications), Bactrim, or clindamycin. The drugs were prescribed for skin infections, although boils were of particular interest. A 2005 Vanderbilt study showed 70 percent to 80 percent of boils are caused by CA-MRSA.
From 2001 through 2007, the number of CA-MRSA infections seen in Vanderbilts Adult and Pediatric Emergency Departments increased dramatically. For instance, there were approximately 150 drained abscesses in 2001 (one every two to three days). In 2007, there were more than 1,600 abscesses that were drained (approximately four per day).
Larger boils are typically drained and patients are prescribed antibiotics. But in this new study, children who had drainage procedures and were prescribed either Bactrim or a penicillin-based drug had more than twice the rate of treatment failure or recurrence when compared with children who received clindamycin. Penicillin drugs were still working well to treat non-boil-type skin infections like impetigo.
The study also found the rate of prescribing Bactrim rose dramatically in Tennessee from 2004 to 2007, from 4 percent to almost 40 percent. Doctors may have been choosing Bactrim over clindamycin for two simple reasons: it tastes better, and is cheaper.
When MRSA became the predominant skin bug, we all went scrambling for an oral antibiotic that would work. Bactrim looked like it worked in the lab, but it has not been put to the test in clinical trials with these skin infections in people, Creech said.
Lab tests show little or no CA-MRSA resistance to Bactrim, but Derek Williams, M.D., MPH, instructor of Pediatrics and lead author of the current study, says MRSA may get around the drug by borrowing tools from a patients own body.
Clindamycin had already been in use for serious MRSA infections of the bone and other tissues, and we know it works well, yet we only saw a modest increase in its use for these minor skin infections, Williams said.
Williams and Creech say this study is a preliminary first step since it takes a long time to do the prospective research that will change the standard of care. Vanderbilt is participating in such a trial.
Meanwhile, this study is strongly suggestive and has good evidence behind it that physicians should stop and think twice. Bactrim may not be the best choice for skin boils, Williams said.
More information: pediatrics.aappubl… cations.org/
Provided by Vanderbilt Medical Center
- Dramatic surge seen in kids hospitalized with MRSA May 17, 2010 | not rated yet | 0
- Careful cleaning of children's skin wounds key to healing, regardless of antibiotic choice Feb 21, 2011 | not rated yet | 0
- Community-acquired MRSA becoming more common in pediatric ICU patients Mar 26, 2010 | not rated yet | 0
- Study shows sharp national rise in skin infections, MRSA suspected Jul 28, 2008 | not rated yet | 0
- New, virulent strain of MRSA poses renewed antibiotic resistance concerns Dec 22, 2009 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Why is zone 1 in liver more prone to ischemic injury?
6 hours ago Hi, Is it because around central vein, there is only deoxygenated blood from the vein where as in the periphery there is hepatic artery. Also why...
How can there be villous adenoma in colon, if there are no villi there
May 22, 2013 As title suggest. Thanks :smile:
How can there be a term called "intestinal metaplasia" of stomach
May 21, 2013 Hello everyone, Ok Stomach's normal epithelium is simple columnar, now in intestinal type of adenocarcinoma of stomach it undergoes "intestinal...
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
- More from Physics Forums - Medical Sciences
More news stories
An independent panel of experts on Wednesday recommended US approval of a new Merck sleeping pill called suvorexant, but expressed concerns over the highest dosage and risks of drowsy daytime driving.
Medications 15 hours ago | not rated yet | 0
GlaxoSmithKline PLC says it's starting an unusual collaboration with the U.S. government to develop several antibiotics for both bioterrorism threats and bacterial infections resistant to current medicines.
Medications 17 hours ago | not rated yet | 0
The new 13-valent pneumococcal conjugate vaccine (PCV13) appears to be as safe as the previous version used prior to 2010, the 7-valent pneumococcal conjugate vaccine (PCV7), according to a Kaiser Permanente study published ...
Medications 22 hours ago | not rated yet | 0
The University of Gothenburg Vaccine Research Institute (GUVAX) announces successful results in a placebo controlled phase I study of an oral, inactivated Escherichia coli diarrhea vaccine.
Medications May 22, 2013 | not rated yet | 0
For the first time, physicists from the Max Planck Institute for Extraterrestrial Physics (MPE), biologists and physicians demonstrated the synergistic effect of cold atmospheric plasma - a partly ionized ...
1 hour ago | 5 / 5 (1) | 0 |
(Medical Xpress)—Scientists from the Joint Center for Structural Genomics (JCSG) at SLAC National Accelerator Laboratory have determined the 3-D structure of the chemically active part of an enzyme involved ...
43 minutes ago | not rated yet | 0 |
(Medical Xpress)—Research by U of T Mississauga psychology professor Glenn Schellenberg reveals that two key personality traits – openness-to-experience and conscientiousness—predict better than IQ ...
23 minutes ago | not rated yet | 0 |
Professor Michael Jennings, Deputy Director of the Institute for Glycomics at Griffith University, was part of an international team that discovered the previously unknown pathway of how the bacterium colonizes people.
1 minute ago | not rated yet | 0 |
Aggressive forms of bladder cancer involve the protein PODXL – a discovery that could hold the key to improved treatment, according to researchers at Lund University, Uppsala University and KTH in Sweden.
33 minutes ago | 5 / 5 (1) | 0
A study from the June issue of Anesthesiology found feedback from the front region of the brain is a crucial building block for consciousness and that its disruption is associated with unconsciousness when the anesthetics ketami ...
1 hour ago | not rated yet | 0