Antibiotics Not Required for Healing of Simple Cutaneous Abscesses

[Admin]

NEW YORK (Reuters Health) Apr 20 - A course of antibiotics is not required following incision and drainage of simple cutaneous abscesses, a team at the University of Pennsylvania in Philadelphia report in an April 11th online release of an article in press for the Annals of Emergency Medicine.

Guidelines on the best management of abscesses are not clear, Dr. Abigail Hankin and Dr. Worth W. Everett note. Current guidelines from the Infectious Diseases Society of America and the Centers for Disease Control and Prevention state that incision and drainage alone is adequate. However, recurrent abscesses should be presumed to be infected with methicillin-resistant Staphylococcus aureus (MRSA), and should be treated with antibiotics.

The two investigators reviewed the literature and identified five studies and one abstract that directly addressed the issue of use of antibiotics in treating abscesses.

In presenting their findings in the Best Available Evidence section of the Annals, Drs. Hankin and Everett write that "each of the studies concluded that patients treated with incision and drainage alone exhibit resolution of their infection at the same rate as patients who are treated with incision and drainage plus antibiotic therapy."

Both groups showed a greater than 90% resolution of symptoms without complications.

None of the studies addressed cases in which there is significant cellulitis accompanying the abbess. Reuters Health asked Dr. Everett about this

"Only one pediatric study suggested that overlying cellulitis > 5cm was predictive of later hospitalization," Dr. Everett explained. "But for the practicing clinician, in general, if the extent of the redness is limited to the skin overlying the abscess or only slightly beyond, simple incision and drainage would be recommended. Presence of systemic symptoms (fever, vomiting, etc.) felt to be related to the infection would warrant consideration of antibiotic therapy, but not an absolute," he advised.

Overall, Dr. Everett said, it's a matter of balancing probable benefits and risks. "No practicing physician has a crystal ball and can absolutely predict who will go on to clinical resolution or failure, so almost as important as deciding which course to take is to make sure the patient understands that the wound needs to be rechecked in 2 days and possibly again later to ensure proper healing."

Not using antibiotics means less cost and inconvenience to the patient, Dr. Everett pointed out. "At the same time we are not introducing the elements of adverse medication reactions and side effects, the possibility of drug-drug interactions for those taking other medications, and the potential for breeding antibiotic resistant organisms."

However, questions remain and a multicenter, randomized, placebo-controlled trial is "sorely needed," the U Penn team says.

Ann Emerg Med 2007.