Soap and water might not seem more powerful than a strong antibiotic, but according to a new Johns Hopkins Children's Centerstudy, it might be more important to curing antibiotic-resistant infections in children than a prescribed medication.
In work published in the March issue of Pediatrics, researchers found proper wound cleaning and draining to be more beneficial to curing skin infections due to MRSA (methicillin-resistant Staphylococcus aureus, an antibiotic-resistant bacterium) than the choice of antibiotic used.
Drug comparison
The researchers originally set out to compare the efficacy of two antibiotics commonly used to treat staph skin infections, randomly giving 191 children either cephalexin, a classic anti-staph antibiotic known to work against the most common strains of the bacterium but not MRSA, or clindamycin, known to work better against the resistant strains.
Much to the researchers' surprise, they said, drug choice didn't matter: 95 percent of the children in the study recovered completely within a week, regardless of which antibiotic they got.
Proper wound care
The finding led the research team to conclude that proper wound care, not antibiotics, may have been the key to healing.
"The good news is that no matter which antibiotic we gave, nearly all skin infections cleared up fully within a week," says study lead investigator Aaron Chen, M.D., an emergency physician at Hopkins Children's.
Chen said the better news might be that “good low-tech wound care” -- cleaning, draining and keeping the infected area clean -- is what truly makes the difference between rapid healing and persistent infection.
According to Chen, proper wound care has always been the cornerstone of skin infection treatment, but the researchers suggest more doctors have started prescribing antibiotics preemptively in recent years.
Further studies recommended
Although the Johns Hopkins investigators stop short of advocating against prescribing antibiotics for uncomplicated MRSA skin infections, they call for studies that directly measure the benefit -- if any -- of drug therapy versus proper wound care.
The best study, they say, would compare patients receiving placebo with those on antibiotics, along with proper wound cleaning, draining and dressing.
Antibiotics can have serious side effects, fuel drug resistance and raise the cost of care significantly, the researchers say.
"Many physicians understandably assume that antibiotics are always necessary for bacterial infections, but there is evidence to suggest this may not be the case," said senior investigator George Siberry, M.D., M.P.H., a Hopkins Children's pediatrician and medical officer at the Eunice Kennedy Shriver Institute of Child Health & Human Development. "We need studies that precisely measure the benefit of antibiotics to help us determine which cases warrant them and which ones would fare well without them."
Antibiotic parity
The 191 children in the study, ages 6 months to 18 years, were treated for skin infections at Hopkins Children's from 2006 to 2009.
Of these, 133 were infected with community-acquired MRSA, and the remainder had simple staph infections with non-resistant strains of the bacterium.
Community-acquired (CA-MRSA) is a virulent subset of the bacterium that's not susceptible to most commonly used antibiotics. Most CA-MRSA causes skin and soft-tissue infections, but in those who are sick or have weakened immune systems, it can lead to invasive, sometimes fatal, infections.
At 48-hour to 72-hour follow-ups, children treated with both antibiotics showed similar rates of improvement -- 94 percent in the cephalexin group improved and 97 percent in the clindamycin group improved.
By one week, the infections were gone in 97 percent of patients receiving cephalexin and in 94 percent of those on clindamycin.
Those younger than one year of age and those whose infections were accompanied by fever were more prone to complications and more likely to be hospitalized.
