Journal Club Summary

Methodology Score: 4/5                   
Usefulness Score: 2/5
Miller LG, et al.
N Engl J Med. 2015 Mar 19;372(12):1093-103.

Editorial: Choosing an antibiotic for skin infections.

Wessels MR
N Engl J Med. 2015 Mar 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: 

These clinical trial terms have different meanings but are often confused. Concealment refers to the process whereby the treatment allocation is made unknown or concealed prior to patient randomization. This helps prevent selection bias by ensuring that health providers and research staff are not tempted to include or exclude cases according to their views on the allocated treatment. Blinding refers to the methods employed after randomization to ensure that patients, health care providers, and research staff cannot determine whether the patient is receiving the study or the control treatment. This reduces ascertainment bias (the likelihood of differential assessment of outcome).
By: Dr. Venkatesh Thiruganasambandamoorthy