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.
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.