Sulfamethoxazole-Trimethoprim (Cotrimoxazole) for Skin and Soft Tissue Infections Including Impetigo, Cellulitis, and Abscess

Asha Bowen, Jonathan Carapetis, Bart Currie, V. G. Fowler, H. F. Chambers, Steven Tong

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Abstract

Skin and soft tissue infections (SSTI) affect millions of people globally, which represents a significant burden on ambulatory care and hospital settings. The role of sulfamethoxazole-trimethoprim (SXT) in SSTI treatment, particularly when group A Streptococcus (GAS) is involved, is controversial. We conducted a systematic review of clinical trials and observational studies that address the utility of SXT for SSTI treatment, caused by either GAS or Staphylococcus aureus, including methicillin-resistant (MRSA). We identified 196 studies, and 15 underwent full text review by 2 reviewers. Observational studies, which mainly focused on SSTI due to S aureus, supported the use of SXT when compared with clindamycin or β-lactams. Of 10 randomized controlled trials, 8 demonstrated the efficacy of SXT for SSTI treatment including conditions involving GAS. These findings support SXT use for treatment of impetigo and purulent cellulitis (without an additional β-lactam agent) and abscess and wound infection. For nonpurulent cellulitis, β-lactams remain the treatment of choice.
Original languageEnglish
Article numberofx232
Pages (from-to)1-7
Number of pages7
JournalOpen Forum Infectious Diseases
Volume4
Issue number4
DOIs
Publication statusPublished - 2 Nov 2017

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Impetigo
Soft Tissue Infections
Cellulitis
Sulfamethoxazole Drug Combination Trimethoprim
Abscess
Lactams
Skin
Streptococcus
Observational Studies
Therapeutics
Clindamycin
Wound Infection
Methicillin-Resistant Staphylococcus aureus
Ambulatory Care
Randomized Controlled Trials
Clinical Trials

Cite this

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title = "Sulfamethoxazole-Trimethoprim (Cotrimoxazole) for Skin and Soft Tissue Infections Including Impetigo, Cellulitis, and Abscess",
abstract = "Skin and soft tissue infections (SSTI) affect millions of people globally, which represents a significant burden on ambulatory care and hospital settings. The role of sulfamethoxazole-trimethoprim (SXT) in SSTI treatment, particularly when group A Streptococcus (GAS) is involved, is controversial. We conducted a systematic review of clinical trials and observational studies that address the utility of SXT for SSTI treatment, caused by either GAS or Staphylococcus aureus, including methicillin-resistant (MRSA). We identified 196 studies, and 15 underwent full text review by 2 reviewers. Observational studies, which mainly focused on SSTI due to S aureus, supported the use of SXT when compared with clindamycin or β-lactams. Of 10 randomized controlled trials, 8 demonstrated the efficacy of SXT for SSTI treatment including conditions involving GAS. These findings support SXT use for treatment of impetigo and purulent cellulitis (without an additional β-lactam agent) and abscess and wound infection. For nonpurulent cellulitis, β-lactams remain the treatment of choice.",
author = "Asha Bowen and Jonathan Carapetis and Bart Currie and Fowler, {V. G.} and Chambers, {H. F.} and Steven Tong",
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Sulfamethoxazole-Trimethoprim (Cotrimoxazole) for Skin and Soft Tissue Infections Including Impetigo, Cellulitis, and Abscess. / Bowen, Asha; Carapetis, Jonathan; Currie, Bart; Fowler, V. G.; Chambers, H. F.; Tong, Steven.

In: Open Forum Infectious Diseases, Vol. 4, No. 4, ofx232, 02.11.2017, p. 1-7.

Research output: Contribution to journalReview articleResearchpeer-review

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AU - Carapetis, Jonathan

AU - Currie, Bart

AU - Fowler, V. G.

AU - Chambers, H. F.

AU - Tong, Steven

PY - 2017/11/2

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AB - Skin and soft tissue infections (SSTI) affect millions of people globally, which represents a significant burden on ambulatory care and hospital settings. The role of sulfamethoxazole-trimethoprim (SXT) in SSTI treatment, particularly when group A Streptococcus (GAS) is involved, is controversial. We conducted a systematic review of clinical trials and observational studies that address the utility of SXT for SSTI treatment, caused by either GAS or Staphylococcus aureus, including methicillin-resistant (MRSA). We identified 196 studies, and 15 underwent full text review by 2 reviewers. Observational studies, which mainly focused on SSTI due to S aureus, supported the use of SXT when compared with clindamycin or β-lactams. Of 10 randomized controlled trials, 8 demonstrated the efficacy of SXT for SSTI treatment including conditions involving GAS. These findings support SXT use for treatment of impetigo and purulent cellulitis (without an additional β-lactam agent) and abscess and wound infection. For nonpurulent cellulitis, β-lactams remain the treatment of choice.

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