Sulfamethoxazole-Trimethoprim (Cotrimoxazole) for Skin and Soft Tissue Infections Including Impetigo, Cellulitis, and Abscess

Asha C. Bowen, Jonathan R. Carapetis, Bart J. Currie, Vance Fowler, Henry F. Chambers, Steven Y. C. Tong

Research output: Contribution to journalReview article

Abstract

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.

Original languageEnglish
Article number232
Number of pages7
JournalOpen Forum Infectious Diseases
Volume4
Issue number4
DOIs
Publication statusPublished - 2017

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