The effectiveness of antibiotics for skin and soft tissue infections in children

The emergence and spread of methicillin-resistant strains of Staphylococcus aureus (MRSA) not only in hospitals, but also in a community setting, requires regular analysis of effectiveness of various antibiotics used to treat skin and soft tissue infections (ICMT). The results of an epidemiological study conducted by Hersh et al. Showed that in the United States from 1997 to 2005, the overall frequency of requests for medical care increased by 50%, in addition, the proportion of active drugs against MRSA has increased in the structure of antibiotic prescriptions (from 7% to 28%).

In a study by a group of American pediatricians led by DJ Williams, the results of which are presented in the journal Pediatrics in August 2011, analyzed the comparative efficacy of beta-lactams, cotrimoxazole and clindamycin in children with ICMT, while clindamycin was considered a "reference" drug for treatment. this nosology.

In this retrospective cohort study, the results of treatment for almost 47,501 children with ICMT were analyzed. Cases of ICTM in children with burns, postoperative wound infections and infections associated with the presence of foreign bodies were excluded from the analysis.

The criteria for evaluating the efficacy of the treatment were the frequency of cases of clinical treatment failure (i.e., the persistence or resumption of symptoms of the ICMT within 14 days after the initial treatment) and the frequency of relapses (repeated case of the ICMT in the period from 15 to 365 days after the initial episode). In addition, all the patients were divided into 2 groups: the patients of the first group underwent surgical drainage of the focal point of the infection, and only conservative treatment was carried out in the children of the 2nd group.

Clindamycin, which was considered the standard for ICMT treatment, was received by 15.7% of the children. Cotrimoxazole was prescribed in 22.3% of cases, and beta-lactams - in 61.9% of children with ICMT.

Treatment failure was noted in 568 (8.9%), and a recurrence of the CGI was observed in 994 (22.8%) of the 6407 children who underwent surgical treatment. In cotrimoxazole treatment, the odds ratio (OR) adjusted for treatment failure was 1.92 (95% confidence interval - CI 1.49 to 2.47); and the risk of OR relapse was found to be 1.26 (95% CI 1.06 to 1.49). Similar OS indicators for beta-lactam antibiotics in the treatment of CMPI in children in this group were 2.23 (95% CI 1.71-2.90) and 1.42 (CI 95% from 1.19 to 1.69), accordingly.

In children who did not undergo surgical treatment (n = 41094), 2435 cases of therapeutic failure (5.9%) and 5436 cases of relapse ICMT (18.2%) were recorded. The ORs adjusted for clinical ineffectiveness were 1.67 (95% CI 1.44 to 1.95) for cotrimoxazole and 1.22 (95% CI 1.06 to 1.41) for beta-lactam antibiotics. When analyzing the recidivism rate, similar values of the adjusted OR were 1.30 (95% CI 1.18 to 1.44) and 1.08 (95% CI 0.99) at 1.18) for cotrimoxazole and beta lactams, respectively.

Despite the fact that the retrospective study had certain limitations (in particular, the results of microbiological studies were not analyzed in this study, possible errors in the classification of treatment results are not excluded), its results are without no significant doubts for the clinical practice of managing children with skin and soft tissue infections. The likelihood of clinical treatment failure or relapse in children with ICTM was significantly higher with beta-lactams and cotrimoxazole than with clindamycin. The most pronounced differences in efficacy were noted in the group of children with more severe (complicated) ICMT requiring surgical drainage.