Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections

Journal Club SummaryMethodology Score: 4/5                   Usefulness Score: 2/5
Miller LG, et al.N Engl J Med.2015Mar 19;372(12):1093-103.Full Article
Editorial: Choosing an antibiotic for skin infections.Wessels MRN Engl J Med.2015Mar 19;372(12):1164-5.
This multicenter, prospective, randomized, double-blind trial compared the treatment of uncomplicated skin infections with clindamycin versus TMP-SMX. Designed as a superiority trial, cure rates did not differ significantly, and neither intervention was found to be superior. The study enrolled healthy patients only, with rigorous exclusion criteria, which does not reflect our patient population. In addition, 77% of all patients with S. aureus were MRSA (32% of the study patients grew MRSA), a much higher rate than within our center. By: Dr. Jillian Ritsma
Epi lesson:  Allocation Concealment vs. BlindingThese clinical trial terms have different meanings but are often confused. Concealment…

Focus on POCUS: Palpitations and Dyspnea Post-AVR

This case is brought to you by Dr. Robert Ohle, PGY5 in emergency medicine, who assessed the patient and captured all of the ultrasound images!Case Vignette:A female in her 20's presents to the emergency department 15 days after major cardiac surgery to repair a congenital aortic valve defect. Her chief complaint is palpitations and shortness of breath, which have been constant and ongoing for the last 4 days. She has no PND or orthopnea, no calf swelling, or history of DVT/PE. She has no past medical history other than the aortic valve defect and is on no medications.Her exam shows a well looking young female in no acute distress. Her vitals are BP 110/40, HR 110, afebrile, O2 99% on room air, RR 18. Her sternotomy incision site looks healthy. Her lungs are clear and there is a loud cardiac murmur, but both the senior resident and staff are unable to tell if it is systolic or diastolic because of the patient’s tachycardia. There are no signs of DVT.Routine bloodwork including car…