Small Abscesses Do Better With Antibiotics

Spoon Feed
Even small abscesses, <5cm, benefitted from antibiotics.  This is contrary to some prior studies' findings that I&D alone was adequate for small abscesses.  TOTAL EM did a podcast on this article.

Why does this matter?
In the MRSA era, antibiotics even for small abscesses seem to improve outcome.  Past study and dogma suggested I&D was all that was needed for small abscesses.

Pus must bust
This was a double-blinded RCT of outpatient children and adults with abscesses 5cm or less who all had I&D and either clindamycin, TMP/SMX, or placebo.  Cure rate at 7-10 days after treatment was better in both the clindamycin and TMP/SMX groups than placebo, NNT = ~8.  New infection at one month was lower only in the clindamycin group.  However, those in the clindamycin group had greater risk for adverse reaction, mainly self-limited diarrhea.  Only patients with S. aureus benefitted from treatment, and 67% were MRSA or MSSA.

Source
A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses.  N Engl J Med. 2017 Jun 29;376(26):2545-2555. doi: 10.1056/NEJMoa1607033.

Peer reviewed by Thomas Davis, MD.

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