Infection known as Cellulitis, a common inflammation often presented at primary care clinics, can best be treated in most cases using trimethoprim-sulfamethoxazole (TMP-SMX), reported researchers here at the American Academy of Family Physicians (AAFP) 2010 Scientific Assembly. Treatment failures observed on other antibiotics was significant.
Joshua Tessier, DO, Iowa Lutheran Family Medicine Residency, Des Moines, Iowa, led a retrospective chart review designed to investigate the odds of adverse events in the treatment of cellulitis with TMP-SMX, and to evaluate current outpatient prescribing practices for cellulitis. Given that a little more than half of all cases of Staphylococcus aureus are community acquired and methicillin resistant, the team wanted to determine whether TMP-SMX was actually doing the job for which it was intended, he explained.
"Based on anecdotal reports in our clinic, people were reporting that they were seeing more reactions to TMP-SMX than other antibiotics. We suspected that this was due to the fact that it is prescribed more because it is cheaper than other medicines [rather than that it actually caused more side effects]," Dr. Tessier stated here at a presentation on October 2. "Our intent in this study was to look at the number of people who had cellulitis and, out of that number, how many were prescribed TMP-SMX versus other antibiotics and, out of that number, the number of adverse reactions in one group from the other."
The research team performed a review of 348 patients seen at 4 primary care clinics. All subjects had been diagnosed with cellulitis based on International Statistical Classification of Diseases and Related Health Problems (ICD-9) codes and had been treated with a single antibiotic. Individuals who had been prescribed more than 1 oral antibiotic at the start of the visit, had a history of immunosuppression or a diagnosis of cellulitis prior to the initial visit were excluded. Upon application of these screening techniques, 290 patients remained in the study cohort.The researchers charted when and why the patients returned, including scheduled follow-up, patient-directed visits, emergency room visits, and hospitalisation. They also analysed demographics, including age, gender, and drug allergies.
Patients on TMP-SMX were more likely to have a return visit compared with those taking other antibiotics, but these results were not statistically significant. Female patients had nearly 87% greater odds of returning, although this was not ultimately statistically significant either. "We felt that it was important to include these data, because they were so clearly in our numbers, but when we did the data analysis, there was a really broad range in the number of visits and how often females actually came back," Dr. Tessier noted.
Treatment-failure results were significant, however. "Patients not on TMP-SMX who were receiving another antibiotic prescription had 3.6 [95% confidence interval, 1.227 to 10.549] times greater odds of treatment failure," the team reported. As a result, Dr. Tessier stated, "Patients given an antibiotic other than TMP-SMX were more likely to experience treatment failure [and] the current study supports the use of TMP-SMX as a first-line treatment of cellulitis when clinically indicated."
Dr. Tessier added that, according to these numbers, TMP-SMX allows for greater coverage of Staphylococcus- and Streptococcus-related cellulitis than other antibiotics. There were not any greater side effects with the most commonly prescribed antibiotics (TMP-SMX, cephalexin, or doxycycline), so the treatment-failure numbers became very important.
Funding for this study provided by an AAFP Foundation Research Grant.
Joshua Tessier, DO, Iowa Lutheran Family Medicine Residency, Des Moines, Iowa, led a retrospective chart review designed to investigate the odds of adverse events in the treatment of cellulitis with TMP-SMX, and to evaluate current outpatient prescribing practices for cellulitis. Given that a little more than half of all cases of Staphylococcus aureus are community acquired and methicillin resistant, the team wanted to determine whether TMP-SMX was actually doing the job for which it was intended, he explained.
"Based on anecdotal reports in our clinic, people were reporting that they were seeing more reactions to TMP-SMX than other antibiotics. We suspected that this was due to the fact that it is prescribed more because it is cheaper than other medicines [rather than that it actually caused more side effects]," Dr. Tessier stated here at a presentation on October 2. "Our intent in this study was to look at the number of people who had cellulitis and, out of that number, how many were prescribed TMP-SMX versus other antibiotics and, out of that number, the number of adverse reactions in one group from the other."
The research team performed a review of 348 patients seen at 4 primary care clinics. All subjects had been diagnosed with cellulitis based on International Statistical Classification of Diseases and Related Health Problems (ICD-9) codes and had been treated with a single antibiotic. Individuals who had been prescribed more than 1 oral antibiotic at the start of the visit, had a history of immunosuppression or a diagnosis of cellulitis prior to the initial visit were excluded. Upon application of these screening techniques, 290 patients remained in the study cohort.The researchers charted when and why the patients returned, including scheduled follow-up, patient-directed visits, emergency room visits, and hospitalisation. They also analysed demographics, including age, gender, and drug allergies.
Patients on TMP-SMX were more likely to have a return visit compared with those taking other antibiotics, but these results were not statistically significant. Female patients had nearly 87% greater odds of returning, although this was not ultimately statistically significant either. "We felt that it was important to include these data, because they were so clearly in our numbers, but when we did the data analysis, there was a really broad range in the number of visits and how often females actually came back," Dr. Tessier noted.
Treatment-failure results were significant, however. "Patients not on TMP-SMX who were receiving another antibiotic prescription had 3.6 [95% confidence interval, 1.227 to 10.549] times greater odds of treatment failure," the team reported. As a result, Dr. Tessier stated, "Patients given an antibiotic other than TMP-SMX were more likely to experience treatment failure [and] the current study supports the use of TMP-SMX as a first-line treatment of cellulitis when clinically indicated."
Dr. Tessier added that, according to these numbers, TMP-SMX allows for greater coverage of Staphylococcus- and Streptococcus-related cellulitis than other antibiotics. There were not any greater side effects with the most commonly prescribed antibiotics (TMP-SMX, cephalexin, or doxycycline), so the treatment-failure numbers became very important.
Funding for this study provided by an AAFP Foundation Research Grant.
Source: DocGuide.com, By Carole VanSickle Ellis
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