Sulfamethoxazole-Trimethoprim (Cotrimoxazole) for Skin and Soft Tissue Infections Including Impetigo, Cellulitis, and Abscess
AuthorBowen, AC; Carapetis, JR; Currie, BJ; Fowler, V; Chambers, HF; Tong, SYC
Source TitleOpen Forum Infectious Diseases
PublisherOXFORD UNIV PRESS INC
University of Melbourne Author/sTong, Steven
Document TypeJournal Article
CitationsBowen, A. C., Carapetis, J. R., Currie, B. J., Fowler, V., Chambers, H. F. & Tong, S. Y. C. (2017). Sulfamethoxazole-Trimethoprim (Cotrimoxazole) for Skin and Soft Tissue Infections Including Impetigo, Cellulitis, and Abscess. OPEN FORUM INFECTIOUS DISEASES, 4 (4), https://doi.org/10.1093/ofid/ofx232.
Access StatusOpen Access
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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