The treatment of skin and soft-tissue infections in pediatrics has been complicated by the constant increase of antibiotic resistance by Staphylococcus aureus. With a retrospective, case-control trial, the efficacy of a treatment, performed in Philadelphia through beta-lactamines, clindamycin or trimetoprim-sulphametoxazole (TMP-SMX) was evaluated in 2096 children (between 0 and 21) with skin infections diagnosed between 2004 and 2007. The use of clindamycin and of TMP-SMX increased from 16% in 2004 to 62% in 2007; there have been 104 cases of failure and 480 recoveries. The lack of recovery was defined by the need of implanting a drainage, of changing the antibiotic, of prescribing a second antibiotic or of hospitalizing the patient within 28 days from diagnosis. Compared to beta-lactamines, clindamycin presented a similar efficacy, while the TMP-SMX was independently associated with an increase in the risk of therapeutical failure (OR 2.35). Other factors independently associated with the lack of recovery were race (OR 2.43), fever (OR 1.94), the presence of an abscess (OR 1.88), antibiotic treatment in the 6 months preceding the infection (OR 1.76) and going to the Emergency Room at first instead of going to the GP (OR 2.77).
Given the fact that abscess diseases needing a drainage have been excluded from the trial, the result cannot be generalized to all skin and soft-tissue infections; in any case, if the infection is superficial and with no abscess (so, very probably caused by a Staphylococcus), the use of beta-lactamine or of clindamycin is the best choice, while TMP-SMX must not be advised, given the wide resistance that the bacterium presents towards this antibiotic association. If the culture shows the presence of a methicillin-resistant Staphylococcus, the use of TMP-SMX is indicated. In the presence of an abscess, it is necessary to lance and drain and, in this case, a recent trial has shown that the adding of TMP-SMX to the drainage doesn’t improve diagnosis.
