AAC Accepts, published online ahead of print on 10 September 2007

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Antimicrob. Agents Chemother. doi:10.1128/AAC.00377-07
Copyright (c) 2007, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

Randomized, Double-Blind, Placebo-Controlled Trial of Cephalexin for Treatment of Uncomplicated Skin Abscesses in a Population at Risk for Community Methicillin-Resistant Staphylococcus aureus Infection

Priya M. Rajendran, David Young^*, Toby Maurer, Henry Chambers, Francoise Perdreau-Remington, Peter Ro, and Hobart Harris

University of California San Francisco School of Medicine. Department of Dermatology (Rajendran and Maurer). Department of Surgery (Young and Harris). Department of Medicine (Remington and Chambers). School of Medicine (Ro)

^* To whom correspondence should be addressed. Email: dyoung{at}sfghsurg.ucsf.edu.

Background– Empirical use of beta-lactam antibiotics, the preferred agents for treating uncomplicated skin and soft-tissue infections, may no longer be appropriate for these infections because of increasing prevalence of community strains of methicillin-resistant Staphylococcus aureus (MRSA). Retrospective studies, however, suggest that outcomes are good even when beta-lactams are used.

Methods– We conducted a randomized, double-blind trial of 166 out-patient subjects comparing placebo to cephalexin 500 mg orally four times for 7 days after incision and drainage of skin and soft tissue abscesses. The primary outcome was clinical cure or failure 7 days after incision and drainage.

Results– S. aureus was isolated from 70.4% of abscess cultures. 87.8% of the isolates tested were methicillin-resistant S. aureus (MRSA), 93% of which were positive for PVL genes. Clinical cure rates were 90.5% (95% confidence interval, 0.82 - 0.96) in the 84 placebo recipients and 84.1% (95% confidence interval 0.74 - 0.91,) in the 82 cephalexin recipients, (difference in the two proportions 0.0006, 95% confidence interval -0.0461 to 0.0472), p = 0.25.

Conclusions– The 90.5% cure rate observed in the placebo arm and 84.1% cure rate in the cephalexin arm provide strong evidence that antibiotics may be unnecessary after surgical drainage of uncomplicated skin and soft tissue abscesses caused by community strains of MRSA.

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