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

Journal Article (Journal Article)

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 β-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 β-lactam agent) and abscess and wound infection. For nonpurulent cellulitis, β-lactams remain the treatment of choice.

Full Text

Duke Authors

Cited Authors

  • Bowen, AC; Carapetis, JR; Currie, BJ; Fowler, V; Chambers, HF; Tong, SYC

Published Date

  • January 1, 2017

Published In

Volume / Issue

  • 4 / 4

Electronic International Standard Serial Number (EISSN)

  • 2328-8957

Digital Object Identifier (DOI)

  • 10.1093/ofid/ofx232

Citation Source

  • Scopus