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Trimethoprim-Sulfamethoxazole Dose and Methicillin-Resistant Staphylococcus aureus Infections

Cadena J, Nair S, Henao-Martinez AF, et al. Dose of trimethoprim-sulfamethoxazole to treat skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2011; 55:5430–2.

The Infectious Diseases Society of America guideline dealing with the management of methicillin-resistant Staphylococcus aureus (MRSA) infections indicate that incision and drainage without concomitant antibiotic therapy is the preferred method of management of most cutaneous abscesses due to this organism. It also, however, suggests a number of choices that might be considered when antibiotic therapy is thought to be also indicated. Among these suggestions is trimethoprim/sulfamethoxazole (TMP/SMX). The guideline, however, fails to make a firm recommendation concerning the appropriate dose of this fixed combination and clinicians prescribe it in varying doses, most frequently twice daily administration of either 160 mg/800 mg (single strength) or 320 mg/1600 mg (double strength). Cadena and colleagues have addressed the issue of whether the higher dose is more effective in adults with skin and skin structure infections due to MRSA in a case-control study nested within a prospective observational cohort.

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