trimethoprim--sulfamethoxazole-drug-combination and Skin-Diseases--Infectious

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Cephalosporins; Clindamycin; Drug Combinations; Erythromycin; Humans; Methicillin; Metronidazole; Nalidixic Acid; Penicillin Resistance; Penicillins; Rifampin; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus aureus; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

The objective was to optimize antibiotic choice and duration for uncomplicated skin/soft tissue infections (SSTIs) discharged from pediatric emergency departments (EDs) and urgent cares (UCs).. Pediatric patients aged 0 to 18 years discharged from 3 pediatric EDs and 8 UCs with a diagnosis of uncomplicated SSTIs were included. Optimal treatment was defined as 5 days of cephalexin for nonpurulent SSTIs and 7 days of clindamycin or trimethoprim/sulfamethoxazole for purulent SSTIs. Exclusion criteria included erysipelas, folliculitis, felon, impetigo, lymphangitis, paronychia, perianal abscess, phlegmon, preseptal or orbital cellulitis, and cephalosporin allergy. Baseline data were collected from January 2018 to June 2019. Quality improvement (QI) interventions began July 2019 with a revised SSTI guideline, discharge order set, and maintenance of certification (MOC) QI project. MOC participants received 3 education sessions, monthly group feedback, and individual scorecards. Balancing measures included return visits within 10 days requiring escalation of care. Data were monitored through March 2021.. In total, 9306 SSTIs were included. The MOC QI project included 50 ED and UC physicians (27% of eligible physicians). For purulent SSTI, optimal antibiotic choice, plus duration, increased from a baseline median of 28% to 64%. For nonpurulent SSTI, optimal antibiotic choice, plus duration, increased from a median of 2% to 43%. MOC participants had greater improvement than non-MOC providers (P < .010). Return visits did not significantly change pre- to postintervention, remaining <2%.. We improved optimal choice and reduced duration of antibiotic treatment of outpatient SSTIs. MOC participation was associated with greater improvement and was sustained after the intervention period.

Topics: Abscess; Ambulatory Care Facilities; Anti-Bacterial Agents; Cephalexin; Child; Clindamycin; Emergency Service, Hospital; Humans; Retrospective Studies; Skin Diseases, Infectious; Soft Tissue Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Return visits to the emergency department (ED) and subsequent readmissions are common for patients who are unable to fill their prescriptions. We sought to determine if dispensing medications to patients in an ED was a cost-effective way to decrease return ED visits and hospital admissions for skin and soft tissue infections (SSTIs).. A retrospective review of ED visits for SSTIs, during the 24 weeks before and after the implementation of a medication dispensing program, was conducted. Charts were analyzed for both ED return visits and hospital admissions within 7 days and 30 days of the initial ED visit. Return visits were further reviewed to determine if the clinical conditions on subsequent visits were related to the initial ED presentation. A cost analysis comparing the cost of treatment to cost savings for return visits was also performed.. Before the implementation of the medication dispensing program, the return rate in 7 days for the same condition was 9.1% and the rate of admission was 2.8%. The return rate for the same condition in 8-30 days was 2.1% and the rate of admission was 1.0%. After the implementation of the medication dispensing program, the return rate for the same condition in 7 days was 8.0%, and the admission rate was 1.7%. The return rate for the same condition in 8-30 days was 0.8%, and the admission rate was 0%. The total cost of dispensed medications was $4050, while total cost savings were estimated to be $95,477.. A medication dispensing program in the ED led to a reduction in return visits and admissions for SSTIs at both 7 days and 30 days. For a cost of only $4050, an estimated total of $95,477 was saved. A medication dispensing program is a cost-effective way to reduce return visits to the ED and subsequent admissions for certain conditions.

Topics: Abscess; Anti-Bacterial Agents; Cellulitis; Cephalexin; Clindamycin; Cost Savings; Cost-Benefit Analysis; Costs and Cost Analysis; Delivery of Health Care; Doxycycline; Drug Costs; Emergency Service, Hospital; Health Expenditures; Health Services Accessibility; Hospitalization; Humans; Medication Systems, Hospital; Patient Readmission; Pharmaceutical Services; Pilot Projects; Skin Diseases, Infectious; Soft Tissue Infections; Transportation; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Dermatomyositis; Diagnosis, Differential; Glucocorticoids; Humans; Immunocompromised Host; Magnetic Resonance Imaging; Male; Middle Aged; Muscle, Skeletal; Nocardia Infections; Skin; Skin Diseases, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination

Clinical question In patients with uncomplicated abscesses receiving incision and drainage, does the addition of trimethoprim-sulfamethoxazole result in improved clinical resolution at 7 to 14 days after treatment when compared with placebo? Article chosen Talan DA, Mower WR, Krishnadasan A, et al. Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess. N Engl J Med 2016;374(9):823-32.. The primary objective of this study was to compare the clinical cure rates at 7 to 14 days after the end of the treatment period among patients receiving either trimethoprim-sulfamethoxazole (TMP-SMX) or placebo. Secondary outcomes included composite cure; surgical drainage procedures; change in erythema size; presence of swelling, induration, or tenderness; invasive infections; skin infections at the same site and different sites; hospitalizations; similar infections in household contacts; days missed from normal activities; days missed from school or work; and days of analgesic use.

Topics: Abscess; Adult; Anti-Bacterial Agents; Double-Blind Method; Drainage; Emergency Service, Hospital; Female; Humans; Male; Multicenter Studies as Topic; Placebos; Randomized Controlled Trials as Topic; Skin Diseases, Infectious; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Skin and soft tissue infection (SSTIs) due to Staphylococcus aureus, particularly community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), are common in human immunodeficiency virus (HIV)-infected populations in the United States. Studies have differed as to the importance of epidemiological and immunological factors in this relationship, and have employed conflicting strategies for variable selection in multivariate analyses. Developments in causal inference methods in epidemiology have emerged in the last decade to clarify relationships between variables and identify appropriate variables to include in and exclude from multivariate analysis. In this paper, we develop a causal diagram to clarify the pathways linking CA-MRSA and HIV. We focus on the role played by trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis, prescribed to many severely immunocompromised HIV patients and potentially protective against SSTIs, which both mediates and moderates the relationship between immunological parameters and SSTI risk. We demonstrate, using simulated data, that statistical models may yield biased results if they do not account for how HIV viral load may also be a marker of adherence to TMP-SMX prophylaxis. We conclude with a proposed causal model that includes both the epidemiological as well as immunological factors that may explain the increased risk of initial and recurrent SSTI risk in HIV-infected populations.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; CD4 Lymphocyte Count; Community-Acquired Infections; HIV Infections; Humans; Methicillin-Resistant Staphylococcus aureus; Models, Theoretical; Risk Factors; Skin Diseases, Infectious; Soft Tissue Infections; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Viral Load

Topics: Administration, Oral; Administration, Topical; Animals; Anti-Infective Agents; Dog Diseases; Dogs; Insecticides; Male; Mite Infestations; Pyoderma; Skin Diseases, Infectious; Staphylococcal Infections; Toluidines; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Bacteremia; Ceftazidime; Diagnosis, Differential; Humans; Lung Diseases; Male; Melioidosis; Middle Aged; Skin Diseases, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Diagnosis, Differential; Drug Combinations; Humans; Lymphoma, Non-Hodgkin; Male; Nocardia asteroides; Nocardia Infections; Skin Diseases, Infectious; Sporotrichosis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Agranulocytosis; Chlorides; Drug Combinations; Drug Therapy, Combination; Female; Glycogen Storage Disease Type I; Hematopoiesis; Humans; Ketoconazole; Leukocyte Count; Lithium; Lithium Chloride; Neutropenia; Skin Diseases, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A 33-year-old fish fancier developed a protracted skin infection that ultimately was found to be caused by Mycobacterium marinum. The organism was isolated from the lesion as well as from infected fish taken from his home aquarium. The lesion resolved after a six-week course of oral sulfamethoxazole and trimethoprim. Forty-four additional cases of culture-proved M marinum skin infections acquired from aquariums and reported in the English-language literature are reviewed. Almost universally, the lesions remained circumscribed and were either single nodular (14 patients) or multiple sporotrichoid (31 patients). Diagnosis was supported by acid-fast smears (15 patients) and isolation of the organism from skin lesions (43 patients) or from fish (two cases). In vitro studies, as well as clinical outcomes, suggest sulfamethoxazole-trimethoprim or ethambutol hydrochloride plus rifampin to be the drugs of choice.

Topics: Adult; Animals; Anti-Bacterial Agents; Drug Combinations; Fish Diseases; Fishes; Hand Dermatoses; Hobbies; Humans; Male; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Skin Diseases, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Drug Combinations; Enterobacteriaceae Infections; Homosexuality; Humans; Male; Penile Diseases; Sexually Transmitted Diseases; Shigella flexneri; Skin Diseases, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

In the course of a study to determine the nature and type of secondary bacterial infection in dracunculiasis. The most common organisms cultured from lesions were Escherichia coli, Enterobacter and Staphylococcus aureus. E. coli and Enterobacter which were found to carry high morbidity were sensitive to Gentamycin, Claforan and Septrin.

Topics: Cefotaxime; Dracunculiasis; Drug Combinations; Enterobacter; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; Skin Diseases, Infectious; Skin Ulcer; Staphylococcal Skin Infections; Staphylococcus aureus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A 47-year-old Japanese man suffering from T-cell leukemia was examined for multiple subcutaneous abscesses followed to abrasion wound on his right knee. The causative organism was clustered, fine-branched filaments in pus aspirated from the lesions, identified as Nocardia brasiliensis. Most of the lesions regressed from the combined therapy of sulfamethoxazole and trimethoprim, leaving an ulcer on the patient's left leg. The nocardiosis cases in Japan until 1984, including this one, were briefly surveyed.

Topics: Abscess; Drug Combinations; Humans; Japan; Lymphoma; Male; Middle Aged; Minocycline; Nocardia Infections; Skin Diseases, Infectious; Sulfamethoxazole; T-Lymphocytes; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Two cases of cutaneous nocardial infection are reported. The Nocardia species are gram-positive, partially acid-fast bacteria. Cutaneous involvement may develop as one of four types: (1) mycetoma, (2) lymphocutaneous (sporotrichoid) infection, (3) superficial skin infection, or (4) systemic disease with cutaneous involvement. A review of each of these types of infection is included, as well as potential clues that may suggest the diagnosis of nocardiosis.

Topics: Abscess; Aged; Amikacin; Drug Combinations; Facial Dermatoses; Humans; Lymphangitis; Male; Minocycline; Mycetoma; Nocardia; Nocardia asteroides; Nocardia Infections; Skin Diseases, Infectious; Skin Ulcer; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A case of chromobacteriosis in a young Brazilian with toxaemia and multiple skin abscesses is described. The infection responded to treatment with chloramphenicol and cotrimoxazole but recurred 18 months later following insect bites received while fishing in a river. Chromobacterium violaceum was subsequently isolated from the river water. This is the first case of this kind to be reported from South America.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Brazil; Chloramphenicol; Chromobacterium; Drug Combinations; Drug Therapy, Combination; Humans; Male; Recurrence; Sepsis; Skin Diseases, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Water Microbiology

Topics: Adult; Animals; Dermatitis, Occupational; Drug Combinations; Drug Resistance, Microbial; Fishes; Humans; Male; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Skin Diseases, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Animals; Antitubercular Agents; Drug Combinations; Female; Fingers; Fishes; Forearm; Granuloma; Humans; Male; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Skin Diseases, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination