I&D Only or Add Antibiotics?

I&D Only or Add Antibiotics?

Treating skin and soft tissue abscesses with antibiotics in addition to incision and drainage (I&D) resulted in significantly increased clinical cure rate (NNT = 14) and decreased incidence of new lesions (NNT = 10) compared to I&D alone.

When Will Oral Antibiotics for Cellulitis Fail?

When Will Oral Antibiotics for Cellulitis Fail?

”Tachypnea at triage, chronic ulcers, history of MRSA colonization or infection, and cellulitis within the past year,” were the risk factors associated with failure of oral antibiotic therapy for non-purulent cellulitis.

Does Prednisone Help Post-herpetic Neuralgia?

Does Prednisone Help Post-herpetic Neuralgia?

Corticosteroids did not reduce the incidence of post-herpetic neuralgia at 6 months or pain severity at 3, 6, or 12 months. However, the evidence for this review was fairly weak. Two trials indicated that steroids may reduce short-term pain and speed healing at one month.

Does Acyclovir Help Post-herpetic Neuralgia?

Does Acyclovir Help Post-herpetic Neuralgia?

Acyclovir within 72-hours of onset of herpes zoster did not reduce pain from post-herpetic neuralgia better than placebo at 4 to 6-month follow up. But it likely helps with acute pain from zoster at 1-month.

LRINEC Score, Physical Exam, or Imaging for Necrotizing Infection?

LRINEC Score, Physical Exam, or Imaging for Necrotizing Infection?

In this systematic review and meta-analysis, no single aspect of the physical examination, imaging, or LRINEC score had high enough sensitivity to exclude necrotizing soft tissue infections. Contrast CT performed the best, but it was only 94.3% sensitive at best. If you have a high clinical suspicion, early surgical consultation is necessary for definitive diagnosis and management.

Predicting Outpatient Failure for Cellulitis

Predicting Outpatient Failure for Cellulitis

Tachypnea, chronic ulcers, prior MRSA colonization, and prior cellulitis in the past 12 months were all associated with an increased risk of oral antibiotic failure for treatment of non-purulent cellulitis.

Ultrasound For Abscess in Children - The MRSA Era

Ultrasound For Abscess in Children - The MRSA Era

Sonographically occult perineal abscess in children was surprisingly common, 28% (61/217).  More than half had I&D within 4 hours of a "negative" radiology-obtained ultrasound.  Symptoms < 4 days, age < 4 years, and history of MRSA were all associated with false negative ultrasound.

TMP-SMX Better For Abscesses Across the Board

TMP-SMX Better For Abscesses Across the Board

We can't draw firm conclusions from this paper, since it was not designed or powered to detect differences in subgroups with skin abscesses.  But it was notable that patients who received TMP/SMX did better than those who received placebo across all subgroups, including those with larger abscesses; especially those with fever, history of MRSA, or MRSA positive culture.

Small Abscesses Do Better With Antibiotics

Small Abscesses Do Better With Antibiotics

Even small abscesses, <5cm, benefitted from antibiotics.  This is contrary to some prior studies' findings that I&D alone was adequate for small abscesses.

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