Skip to main content

Trimethoprim-Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess

Journal Club Summary

Methodology Score: 3.5/5              
Usefulness Score: 3.5 /5

Talan DA, et al. 
N Engl J Med. 2016 Mar 3;374(9):823-32

This RCT conducted at 5 US emergency departments including over 1200 outpatients aged over 12 years compared treatment of TMP-SMX, 320 mg/1600 mg twice daily for 7 days with placebo for drained skin abscesses ≥2 cm in diameter. The cure rate 7 to 14 days after treatment end was higher in the TMP-SMX group (80.5 versus 73.6 percent). Based on these findings, abscess size ≥2 cm in diameter may be a useful threshold for guiding decisions regarding use of antibiotic therapy after I&D. It should be noted that wound cultures were positive for MRSA in 45 percent of cases, which is surprisingly high and may not apply to most populations. (N.B. percent of MRSA+ swabs at TOH is 18%).
Some limitations of the study included medication adherence, assumed failure of cure when patients were lost to follow up, unclear allocation concealment, and performing multiple comparisons of secondary outcomes without statistical adjustment for such comparisons. 
By: Dr. Julie Kim

Epi lesson:

It is not uncommon for a manuscript to report several secondary outcomes. The number of secondary comparisons is directly proportional to the chance that one of them will end-up being statistically significant by chance alone. To account for this, statisticians should make it proportionally more difficult to find such a statistical difference. The Bonferroni correction suggests that the level of significance (alpha error, 0.05) should be divided by the number of comparisons made i.e. 0.05/5 comparisons = new alpha of 0.01. 
By: Dr. Christian Vaillancourt


Popular posts from this blog

Tips for Success in your Emergency Medicine Rotation

Our wonderful medical students are preparing to start their first clinical rotations. With this in mind here are some of the top tips for success in your EM rotation
1)Be On Time – show up to your shifts on time, better yet 5 minutes early.That first impression is immensely important.
2)Introduce yourself to the team - “Hi my name is John Doe, I am the medical student on shift today” introduce yourself to the attending, residents, nurses, etc.You will be called on a lot more to help when there is something interesting going on if they know your name.
3)Be goal-oriented – have a goal for each shift, whether it’s a procedure or a type of presentation to see.
4)Don’t just stand there, do something – whenever there is a trauma or code, come to the bedside.Get gowned up for traumas and pay attention.Help with things that are within your scope of practice: chest compressions, moving patient, cardioversion
5)Don’t just stand there, do nothing – there are times in medicine when the best thing to d…

2014 Canadian Guidelines for AF Management: Part 1: Introduction and CCS “CHADS-65” Algorithm

by Ian Stiell MD @EMO_Daddy

In this and subsequent postings we will discuss the latest recommendations for ED management of atrial fibrillation (AF) as presented in the newly published 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. The Guidelines PDF can be downloaded from the CCS website at 2014 Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation
The 2014 Focused Update uses the GRADE system of evidence evaluation as was the case in the comprehensive 2010 AF Guidelines and the 2012 Update. The CCS AF Guidelines Panel is comprised of Canadian cardiologists plus physicians from internal medicine, family medicine, neurology, and emergency medicine. This 2014 Update provides evidence review and recommendations for 8 aspects of AF care, including ED Management (written by myself and Dr. Laurent Macle of the Montreal Heart Institute). The 2014 Update focuses on advances in oral anticoagulant (O…

You CAN reverse that! Reversal of NOAC's and more..

We have seen a large surge of the utilization of New Oral Anticoagulants (NOAC's) in the past few years, as such, it has been a novel challenge when these patients present to the Emergency Department (ED) with life threatening bleeding. Dr. Michael Ho looks to discuss treatment options, and future options in these patients. 
NOACs vs WarfarinDabigatran, Rivaroxaban and Apixaban have seen a dramatic increase in use since their approval in Canada. Dabigatran is a direct thrombin (Factor II) inhibitor, while the latter two are direct Xa inhibitors. These drugs are collectively referred to as novel oral anticoagulants (NOACs). They have also been called direct, or target-specific oral anticoagulants (DOACs or TSOACs) [1]. 
The NOACs have many practical advantages over warfarin: Rapid onset of actionShorter half-lifeLess food and drug interferencePredictable pharmacokineticsEase of use and no requirement for monitoringThe downsides to NOACs are the higher cost to the patient, the inabilit…