Antibiotics warranted in pediatric staph infections

For uncomplicated pediatric staph infections, antibiotics are warranted for use in conjunction with lancing and draining affected areas because they reduce the risk of recurrent infections, researchers say.

In a press release on Sept. 26 from the Washington University School of Medicine in St. Louis, the senior author on the paper, Dr. Stephanie A. Fritz, said: “There have been conflicting data about the benefit to antibiotics in minor staph infections.

“It is definitely important to surgically remove pus from the infection site, but also giving antibiotics means that the child will be less likely to see a doctor again in several months for another staph infection.”

Dr. Fritz is a Washington University associate professor of pediatrics in the Division of Infectious Diseases.

In the study, published online ahead of print in Clinical Infectious Diseases (Aug. 24, 2017), 383 children (median age of three years) who had Staphylococcus aureus (staph) infections which required incision and drainage were evaluated. The patients also had colonization of staph in their nostrils or on their skin. Most of the children (355, 93%) received antibiotic treatment in combination with incision and drainage.

The children were monitored several times a year for bacterial colonization and re-infection.

One month after the initial infection, bacterial swabs showed that approximately half of the 355 children (178) who had been treated with antibiotics no longer had staph colonization on their skin or nostrils. This compared to staph colonization remaining on approximately three-quarters of the children who had not received antibiotics (26).

As well, those children who remained colonized one month after their initial infection were approximately twice as likely to experience a recurrent infection, with 60% (101) of children with remaining colonization experiencing recurrence vs. 30% (54) of children without remaining colonization.

These findings suggest that, contrary to perception, routine use of antibiotics for uncomplicated staph infections may reduce the development of antibiotic resistance, said the paper’s lead author, Patrick Hogan, MPH, a clinical research fellow in the university’s School of Medicine.

“Using antibiotics judiciously to treat staph infections eliminates staph colonization and prevents more infection from occurring in the future,” Hogan said. “This reduces the overall burden of the staph germ on the environment and people, which results in less recurrence and, therefore, less antibiotic use.”

The study primarily evaluated the antibiotics clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX). Of those two, clindamycin was the most effective at eliminating the staph colonization and preventing recurrent infection. Why clindamycin was superior to other antibiotics in this study is unknown and should be studied further, Hogan said.