Change in advice for abscess drainage
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.
TMP-SMX is the more preferable option over clindamycin as it is less likely to cause diarrhoea, they added.
The recommendation is in contrast to most of the current guidelines that generally advise uncomplicated skin abscesses be treated with incision and drainage alone except in cases where there is systemic illness, extensive tissue damage, immunocompromising conditions, an artificial joint or a ...