Journal
OPEN FORUM INFECTIOUS DISEASES
Volume 4, Issue 4, Pages -Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/ofid/ofx232
Keywords
group A Streptococcus (GAS); impetigo; skin and soft tissue infections; Staphylococcus aureus; sulfamethoxazole-trimethoprim
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Funding
- Australian National Health and Medical Research Council (NHMRC) early career fellowship scholarship [1088735]
- NHMRC Career Development Fellowship [1065736]
- NHMRC [1131932]
- National Health and Medical Research Council of Australia [1065736] Funding Source: NHMRC
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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 beta-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 beta-lactam agent) and abscess and wound infection. For nonpurulent cellulitis, beta-lactams remain the treatment of choice.
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