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Clinical Therapeutics

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

Priya M. Rajendran, David Young, Toby Maurer, Henry Chambers, Francoise Perdreau-Remington, Peter Ro, Hobart Harris
Priya M. Rajendran
1Department of Dermatology
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David Young
2Department of Surgery
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  • For correspondence: dyoung@sfghsurg.ucsf.edu
Toby Maurer
1Department of Dermatology
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Henry Chambers
3Department of Medicine
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Francoise Perdreau-Remington
3Department of Medicine
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Peter Ro
4University of California San Francisco School of Medicine, San Francisco, California
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Hobart Harris
2Department of Surgery
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DOI: 10.1128/AAC.00377-07
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    Enrollment and outcomes.

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  • TABLE 1.

    Baseline characteristics of the 166 study subjects included in the analyses, by study group

    CharacteristicValue for study group:P value
    CephalexinPlacebo
    Age, median (range), yr43 (22-66)45 (22-88)0.3191
    Male sex (%)72.081.00.2313
    Race (%)0.2431
        American Indian6.20
        Pacific Islander1.51.5
        Asian4.61.5
        African-American38.546.2
        Caucasian49.250.8
    Homeless (%)35.438.10.7493
    Diabetes (%)2.46.00.4432
    Hepatitis B or C (%)30.533.30.7408
    HIV infection (%)15.97.10.0915
    Abscess size of >5 cm in dimension (%)
        Length17.718.11.0000
        Width19.224.10.5668
        Depth1.45.30.3678
        Surface area, mean (range), cm218.7 (1-144)19.0 (1-150)0.3676
        Tissue depth (%)
            Subcutaneous64.167.70.9048
            Fascia17.214.1
            Muscle18.818.3
    Underlying skin disease (%)
        Folliculitis38.840.21.0000
        Atopic dermatitis0.050.011.0000
  • TABLE 2.

    Reasons for clinical failures by study group

    ReasonNo. of subjects in study group:
    Cephalexin (n = 13)Placebo (n = 8)
    Nurse practitioner thought abscess was not healing as expected83
    Patient was prescribed antibiotics for new, nonadjacent abscess02
    Patient returned to emergency department complaining of worsening abscess20
    Patient started on antibiotics for unrelated medical condition during study period01
    Primary care provider urged patient to withdraw from study due to HIV infection10
    Loss to follow-up22
  • TABLE 3.

    Characteristics of the 166 subjects, by clinical outcome

    CharacteristicValue for study group
    CureFailure
    PlaceboCephalexinPlaceboCephalexin
    Shown as no. (%) of subjects
        Male sex61 (80.3)47 (68.1)7 (87.5)12 (92.3)
        Homeless28 (36.8)24 (34.8)4 (50.0)5 (38.5)
        Race
            Pacific Islander1 (1.6)0 (0.0)0 (0.0)0 (0.0)
            Asian2 (3.3)3 (5.6)0 (0.0)0 (0.0)
            African-American27 (44.3)23 (42.6)4 (57.1)4 (40.0)
            Caucasian31 (50.8)28 (51.9)3 (42.9)6 (60.0)
        Hepatitis (B or C)23 (30.3)21 (30.4)5 (62.5)4 (30.8)
        Diabetes5 (6.6)2 (2.9)0 (0.0)0 (0.0)
        Intravenous drug use38 (50.0)32 (46.4)4 (50.0)5 (38.5)
        Tissue depth
            Subcutaneous44 (67.7)34 (63.0)4 (66.7)7 (70.0)
            Fascia9 (13.8)10 (18.5)1 (16.7)1 (10.0)
            Muscle12 (18.5)10 (18.5)1 (16.7)2 (20.0)
    Shown as mean value
        Age (yr)44.242.546.540.9
        Mean amt of pus drained (ml)20.929.314.744.1
        Surface area of abscess (cm2)20.216.87.128.0
  • TABLE 4.

    Pathogen distribution by study group

    OrganismNo. (%) of subjects by study group:
    Cephalexin (n = 80)Placebo (n = 82)
    Staphylococcus aureus only55 (68.8)55 (67.1)
    Streptococcus species only2 (2.5)5 (6.1)
    Both Staphylococcus aureus and Streptococcus species3 (3.8)1 (1.2)
    Neither species20 (25.3)21 (25.6)
  • TABLE 5.

    Antimicrobial susceptibilities of Staphylococcus aureus from abscesses at enrollment, by study groupa

    Antimicrobial agentNo. (%) of isolates for study group:
    Cephalexin (n = 50)Placebo (n = 49)
    Nafcillin6 (12.0)6 (12.2)
    Erythromycin8 (16)7 (14.3)
    Ciprofloxacin25 (50.0)30 (61.2)
    Levofloxacin27 (74.0)39 (79.6)
    Tetracycline39 (88.0)41 (83.7)
    Clindamycin44 (88.0)44 (89.8)
    Rifampin49 (98.0)49 (100)
    Gentamicin50 (100)49 (100)
    Trimethoprim-sulfamethazole50 (100)49 (100)
    Vancomycin50 (100)49 (100)
    Linezolid50 (100)40 (100)
    • ↵ a Of the 110 staphylococcal isolates, antimicrobial susceptibility data were available for 99.

  • TABLE 6.

    Prevalence and cure rates of PVL-producing MRSA, by study group

    Study group and outcomeNo. of isolates
    MRSAPVL positive/testedCures/PVL positive
    Cephalexin (n = 82)
        Cure4038/4138/38
        Failure22/20/2
    Placebo (n = 84)
        Cure3937/3937/37
        Failure43/40/3
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Randomized, Double-Blind, Placebo-Controlled Trial of Cephalexin for Treatment of Uncomplicated Skin Abscesses in a Population at Risk for Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection
Priya M. Rajendran, David Young, Toby Maurer, Henry Chambers, Francoise Perdreau-Remington, Peter Ro, Hobart Harris
Antimicrobial Agents and Chemotherapy Oct 2007, 51 (11) 4044-4048; DOI: 10.1128/AAC.00377-07

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Randomized, Double-Blind, Placebo-Controlled Trial of Cephalexin for Treatment of Uncomplicated Skin Abscesses in a Population at Risk for Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection
Priya M. Rajendran, David Young, Toby Maurer, Henry Chambers, Francoise Perdreau-Remington, Peter Ro, Hobart Harris
Antimicrobial Agents and Chemotherapy Oct 2007, 51 (11) 4044-4048; DOI: 10.1128/AAC.00377-07
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KEYWORDS

Cephalexin
community-acquired infections
methicillin resistance
staphylococcal infections
Staphylococcus aureus

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