Skin abscesses are best treated with incision and drainage plus antibiotics, rather than just incision and drainage alone, recommends an international guideline panel in the BMJ.

After critically appraising all the current evidence, the panel found adjuvant antibiotic therapy in addition to incision and drainage of uncomplicated skin abscesses reduced the risk of treatment failure and abscess recurrence by approximately 13% compared to treatment without additional antibiotics.

In particular the randomised controlled trials included in the review, were evaluating the use of clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) in addition to incision and drainage.

“TMP-SMX or clindamycin modestly reduces pain and treatment failure and probably reduces abscess recurrence, but increases the risk of adverse effects including nausea and diarrhoea,” they said.