Please select the eligibility criteria that correspond to the clinical trial below.
Title: Randomized Placebo-Controlled Trial of Bactrim on 7 Day Outcome in Emergency Department Patients With Uncomplicated Abscesses at Risk for Community Acquired Methicillin Resistant Staph Aureus
Brief Summary: Patients will be enrolled in a multi-center study to prospectively evaluate outcome after treatment for an uncomplicated skin abscess. All patients will receive incision and drainage and wound cultures. Patients will then be randomized to 1) placebo two tablets PO BID X 7 days or 2) bactrim DS (800/160) two tablets PO BID x 7 days. Patients will then return to the emergency department ED) at 48 hours and 7 for wound repacking and evaluation. The primary outcome is treatment failure rates at 7 days after incision and drainage. Patients who are clinically worsening or not improving after 48 hours will then be treated with additional antibiotics or admission if needed. Data will be analyzed both by initial randomization and intention to treat.


Options:
A: Inclusion Criteria:

* Skin and skin structure infection (SSSI) that involves deeper soft tissue or requires significant surgical intervention, or cellulitis or abscess on lower extremity which occurs in subjects with diabetes mellitus or well-documented peripheral vascular disease.

Exclusion Criteria:

* Prior treatment of current complicated skin and skin structure infection (cSSSI) with an antimicrobial.
* Failure of vancomycin or aztreonam as therapy for the current cSSSI, or prior isolation of an organism with in vitro resistance to vancomycin or aztreonam.
B: Inclusion Criteria:

* Written informed consent
* Men or women of 18 years and above with a diagnosis of bacterial skin and skin structure infection that requires

  * Hospitalization and
  * Initial parenteral therapy for at least 48 hours and
  * Meets at least one of the following criteria:

    * Involvement of deep soft tissue (e.g. fascial, muscle layers)
    * Requirement for a significant surgical intervention including surgical drainage, drainage procedure guided by imaging and/or debridement
    * Association with a significant underlying disease that may complicate response to treatment. An underlying disease is considered significant if it includes any of the following conditions that are present at the time of presentation: cancer (except basal- or squamous-cell cancer of the skin), cardiac (i.e., congestive heart disease), diabetes mellitus, hepatic (i.e., cirrhosis or another form of chronic liver disease), immunologic, renal disease, respiratory, transplantation or vascular disease
* Duration of infection \< 21 days
* Diagnosis of one of the following skin and skin structure infections that requires hospitalization and initial parenteral antibiotic therapy for at least 48 hours:

  * Major abscess(es) associated with extensive cellulitis, which requires antibiotic therapy in addition to surgical incision and drainage
  * Diabetic foot infection of mild to severe intensity (perfusion, extent/size, depth/tissue loss, infection and sensation (PEDIS) grade 2-4) in the presence or absence of osteomyelitis. Subjects with osteomyelitis may only be enrolled if the infected bone is completely removed by surgery and if residual infection requiring antibiotics is still present following surgery
  * Wound infection including: post surgical (surgical incision), post-traumatic, human bite/clenched fist and animal bite wound and wound associated with injection drug abuse:

    * Infections must have occurred within 30 days of a surgical procedure, trauma, animal bite, or human bite, and involve the skin and skin structures at the site of the incision, trauma, or bite
    * In addition, post-surgical/trauma wound infections must meet the following criteria:

      * Involvement of deep soft tissues (e.g. fascial and muscle layers) of the incision/trauma
      * At least one of the following criteria:

        * Purulent drainage from the deep incision/trauma
        * Identification of an infecting organism from an aseptically obtained culture of fluid or tissue from incision/trauma
      * At least one of the following signs and symptoms:

        * Localized pain or tenderness
        * Fever (see below) AND the incision (in case of post-surgical wound infections) is deliberately opened by a surgeon, unless the culture is negative
        * Abscess or other evidence of infection involving the deep incision/trauma, found on direct examination, during reoperation/operation (in case of trauma), or by histologic or radiologic examination
      * Diagnosis of a deep incisional/post-trauma Skin Structure Infections (SSI) by a surgeon or attending physician
      * Bite wounds/clenched fist infections and wounds associated with injection drug abuse must meet the criteria defining a Complicated Skin and Skin Structure Infections (cSSSI)
  * Infected ischemic ulcers with at least one of the following conditions:

    * Peripheral vascular disease
    * Conditions pre-disposing to pressure sores such as paraplegia, peripheral neuropathy
    * Presence of at least 3 of the following signs or symptoms:

      * Purulent drainage or discharge
      * Erythema extending \> 1 cm from the wound edge
      * Fluctuance
      * Pain or tenderness to palpation
      * Swelling or induration
      * Fever, defined as body temperature

        * \> 37.5°C (axillary)
        * \> 38°C (orally)
        * \> 38.5°C (tympanically) or
        * \> 39°C (rectally)

          * OR
        * Elevated total peripheral white blood cell (WBC) count \> 12,000/mm3 or
        * \>15 % immature neutrophils (bands) regardless of total peripheral WBC count
      * C reactive protein (CRP) \>20 mg/L
* Specimen obtained for culture from infected area by needle aspiration of obviously purulent material or by tissue biopsy or by curettage of the surface of ulcer within 48 hours prior to the initiation of study drug therapy
* Duration of treatment of the skin/skin structure infection is anticipated to be at least 7 days.
* Surgical drainage or debridement of infected wounds or abscesses, if necessary, have to have been completed \<= 48 hours after the initiation of study drug therapy

Exclusion Criteria:

* Women, who are pregnant or lactating, or in whom pregnancy can not be excluded (Note: a urine pregnancy test has to be performed for all women of childbearing potential before randomization to the study drug)
* The following skin and skin structure infections:

  * Necrotizing fasciitis including Fourniers gangrene, ecthyma gangrenosum, streptococcal necrotizing fasciitis and clostridial necrotizing fasciitis
  * Burn wound infections
  * Secondary infections of a chronic skin disease (e.g. atopic dermatitis)
  * Infection of prosthetic materials (e.g. subcutaneous tissue infection related to a central venous catheter or permanent cardiac pacemaker battery pack). Subjects with removal of a prosthetic device involved in an infection should not be included
  * Infections where a surgical procedure alone is definitive therapy
  * Subjects with uncomplicated skin and skin structure infections including folliculitis and furunculosis, carbunculosis, simple abscesses and superficial cellulitis
* Known hypersensitivity to quinolones and/or any type of beta-lactam antibiotic drugs or any of the excipients
* Previous history of cholestatic jaundice/hepatic dysfunction associated with amoxicillin-clavulanic acid
* Severe, life threatening disease with a life expectancy of less than 2 months
* Immunosuppression including:

  * Known neutropenia (neutrophil count \< 1000/µL)
  * Known lymphopenia with absolute CD4+ T cell count \< 200/mm3
  * Acquired immunodeficiency syndrome (AIDS)-defining event and/or concomitant therapy with Highly Active Antiretroviral Therapy (HAART)
  * Chronic treatment (\>/= 2 weeks) with known immunosuppressant therapy (including treatment with \> 15 mg/day of systemic prednisone or equivalent)
  * Any other congenital or acquired immune defect or immunosuppression
* Known severe hepatic insufficiency (Child Pugh C) or transaminases increase \> 5 fold upper limit of normal (ULN)
* Known renal impairment with a baseline measured or calculated serum creatinine clearance \< 40 mL/min
* Known prolongation of the QT interval or concomitant use of drugs reported to increase the QT interval (e.g. Class IA or Class III antiarrhythmics \[eg., quinidine, procainamide, amiodarone, sotalol\], neuroleptics \[e.g. haloperidol\], tricyclic antidepressive agents, certain antimicrobials \[e.g. pentamidine, halofantrine\], certain antihistaminics \[e.g. terfenadine\], and other \[cisapride, vincamine IV, depridil, diphemanil\])
* Uncorrected hypokalemia
* Clinically relevant bradycardia
* Clinically relevant heart failure with reduced left ventricular ejection fraction (i.e., below 40%)
* Previous history of symptomatic arrhythmias
* Previous history of tendon disease/disorder with quinolones
* Known or suspected concomitant bacterial infection requiring additional systemic antibacterial treatment, e.g. underlying septic arthritis
* Requiring therapy with probenecid
* Treatment with a systemic or topical antibacterial agent for \> 24 hours in the previous 7 days preceding study entry unless the subject showed no response or had worsening of clinical signs and symptoms despite 3 or more days of prior therapy and a culture obtained at the time of subject enrollment showed persistence of a pathogen which is susceptible to the study drugs. The prior antimicrobial therapy must not have been a fluoroquinolone or a beta lactam/beta lactamase combination
* Infection known to be due to a Methicillin-Resistant Staphylococcus Aureus (MRSA), Methicillin-Resistant Staphylococcus Epidermidis (MRSE) or Vancomycin Resistant Enterococcus (VRE) as the single isolated pathogen
* Previous enrolment in this study
* Participation in any clinical investigational drug study within 4 weeks of screening
* Previous history of seizure disorders
C: Inclusion Criteria:

* Inclusion criteria include all patients age 16 and older who present to the emergency department with a skin abscess that requires incision and drainage.

Exclusion Criteria:

* Exclusion criteria include patients with diabetes, HIV, cancer or other immunocompromised patients.
* Additionally, any patients who received antibiotics within one week of presentation or were hospitalized in previous month will be excluded to minimize potential confounding variables.
* Pregnant and breastfeeding patients will also be excluded due to possible safety concerns with antibiotic treatment.
* Patients with abscesses on face, perirectal, or perianal regions, abscesses with known tracks or fistulas to deeper structures, or abscesses requiring surgical drainage in an operating room are excluded.
* Patients with fever or evidence of systemic infection
* Finally, patients with sulfa allergy will be excluded.
D: Inclusion Criteria:

* Diagnosis of acute bacterial skin-structure infection (ABSSI) of no more than 7 days duration which was suspected or proven to be caused, at least in part, by a gram-positive pathogen.
* Eligible infections included cellulitis measuring at least 10 cm length and width or 100 cm squared, with or without a focal abscess, and surgical or traumatic wound infections
* Infection which in the opinion of the investigator will require 10-14 days of antibacterial therapy.
* Have at least 3 of the following local and/or systemic symptoms and/or signs of infection: purulent or seropurulent drainage/discharge, erythema, fluctuance, heat/localized warmth, pain/tenderness to palpation, swelling/induration, regional lymph node swelling or tenderness, temperature \>=100.4 degree F, increased white blood cell count, or bandemia.
* Must not have received treatment with another systemic antibiotic for the current ABSSI.

Exclusion Criteria:

* Superficial skin structure infections such as folliculitis, carbuncles, furunculosis, cutaneous abscesses, and simple cellulitis.
* Infections involving burns, human or animal bites, or chronic diabetic foot ulcers.
* Suspected polymicrobial infection involving Pseudomonas aeruginosa
* Anticipated need for \>14 days of antibiotic therapy.
* Infections complicated by the presence of prosthetic materials that will not be removed, such as permanent cardiac pacemaker battery packs, mesh, or joint replacement prosthesis.
* Known significant renal, hepatic, or hematologic impairment.
* Received prior potentially effective antimicrobial therapy for the acute bacterial skin and skin structure infection, unless they were failing therapy after 48 hours or had a gram-positive pathogen non-susceptible to prior therapy identified as a causative pathogen.

Answer: C