Trimethoprim–Sulfamethoxazole or Placebo for skin Abscess

When we reviewed 3 previous studies here, here and here. We mentioned that should we really treat simple Skin abscess? NEJM published “Trimethoprim–Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess” in March 2016. Patients were randomised to TMP-SMZ 320-1600 mg twice a day for 7 days versus Placebo in patients greater than 12 years old with uncomplicated skin abscess.

Conclusion: In settings in which MRSA was prevalent, trimethoprim–sulfamethoxazole treatment resulted in a higher cure rate among patients with a drained cutaneous abscess than placebo.

Link to article

 

 

Headache Treatment!

Expert panel from American Headache Society Published a guideline! to manage Migraine Headache in ED in Headache June 2016. They searched and found 68 randomized controlled trials. I am very happy to see our routine practice to treat headache in ED, now after years is coming to Neurology Guideline!

Metoclopramide and prochlorperazine offered as level B, and they offered Dexamethasone as Level B to prevent recurrence of Headache!

 

Link to article

Platelet is not safe in Patient with Intracranial hemorrhage on anti platelet therapy

PATCH is a European based study that published in Lancet in May 2016. PATCH is trying to investigate the effects of platelet transfusion on acute intracranial bleed  after using anti-platelet therapy. Study had 2 arms with 95 patients in each arm randomized to standard of care versus platelet transfusion in patient with intracranial bleed on anti platelet therapy . PATCH study is not recommending Platelet transfusion in patients with acute intracerebral hemorrhage who are on anti platelet therapy due to worsening outcome.

 

Link to article

 

 

Clindamycin vs Trimethoprim-sulfamethoxazole for Wound Infection

We discussed this in 2015, but new study in Clinical Infectious Dis. again recommends antibiotic use in uncomplicated wound infection. They do not give an exact meaning of uncomplicated wound infection but we can say whenever physician meant to treat wound infection! This is a randomized, double-blind study at 5 US emergency departments. Patient  received oral clindamycin 300 mg 4 times daily or TMP-SMX 320 mg/1600 mg (2 tab TMP-SMX DS)  twice daily, each for 7 days. They compared outcome @ 7-14 days of treatment and 6-8 weeks post treatment. The conclusion is clindamycin and TMP-SMX produce similar cure and adverse event rates among patients with an uncomplicated wound infection.

 

Link to article

 

Prednisone and Dexamethasone for Asthma

Can we use Dexa instead of Prednisone when we are discharging patient home? old question and as I remember the answer was always Sure! but why are we asking still this question:

Symptomatic improvement following emergency department management of asthma: a pilot study of intramuscular dexamethasone versus oral prednisone. J. Asthma 1997

2 articles within last 2 months in Annals of EM:

1.A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department

2. A Randomized Controlled Noninferiority Trial of Single Dose of Oral Dexamethasone Versus 5 Days of Oral Prednisone in Acute Adult Asthma.