Written by Clay Smith
Spoon Feed
This meta-analysis of 4 RCTs found anti-MRSA antibiotics in addition to I&D led to a far better cure rate than I&D alone.
Why does this matter?
In the past, the literature has gone back and forth about whether or not antibiotics are helpful for abscesses. Is I&D enough? However, more recent studies have shown that both small and large abscesses appear to benefit from giving antibiotics. This meta-analysis pooled several studies to get a consensus.
Yup, give antibiotics
This was a systematic review and meta-analysis of 4 RCTs, mostly using TMP/SMX, with 2406 patients and found the treatment failure rate was 7.7% with antibiotics, 16.1% without. Adverse effects from antibiotics were largely minor (rash, GI upset) and not much worse than placebo, 24.8% with antibiotics, 22.1% without. Fewer patients developed new lesions when given antibiotics. The consensus is in – give anti-MRSA antibiotics for abscesses in addition to I&D.
Source
Systemic Antibiotics for the Treatment of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2018 Mar 9. pii: S0196-0644(18)30142-2. doi: 10.1016/j.annemergmed.2018.02.011. [Epub ahead of print]
Peer reviewed by Thomas Davis.
Counterpoint if I may. in this study, no antibiotics still has a treatment success rate well over 80%. Therefore my practice is only slightly changed. In the young healthy person with no concerning comorbidities and access to follow up, I will continue to hold antibiotics and give good follow up instructions. For patients w/ a large component of cellulitis, immunocompromised, febrile, etc, i will give abx as i have done in the past. What changes is, if i am on the fence, I will now be more likely to give abx.
Antibiotic resistance is still a public health problem and we should continue to practice good antibiotic stewardship.