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A clinical practice guideline for Antibiotics Use after incision and drainage

A clinical practice guideline for Antibiotics Use after incision and drainage

According to recent study antibiotics after incision and drainage improve the chance of short-term cure compared with placebo for small uncomplicated skin abscesses.This triggered Dr.Mieke Vermandere and expert panel to come out with clinical practice guideline for Antibiotics Use after incision and drainage for uncomplicated skin abscesses which has been published in form of an article in BMJ.The infographic presents the recommendations together with other pertinent information, including an overview of the absolute benefits and harms of candidate antibiotics in the standard GRADE format.

A skin abscess is an isolated collection of pus within the dermis and deeper skin tissues. Uncomplicated skin abscesses are collections of pus within the skin structures and are usually caused by bacterial infections. Careful history and clinical examination are usually sufficient to diagnose a skin abscess. Skin abscesses present as single or multiple tender, erythematous, indurated nodules, often surrounded by an area of erythema or swelling.Fluctuance beneath the skin often indicates a fluid-filled cavity. There may be a pustule at the area where the abscess is closest to the skin or spontaneous drainage of pus. The use of point-of-care ultrasonography can help differentiate an abscess from other soft tissue infections in the emergency department.

Major Recommendations :

  • For uncomplicated skin abscesses, we suggest using trimethoprim-sulfamethoxazole (TMP-SMX) or clindamycin in addition to incision and drainage rather than incision and drainage alone, and emphasise the need for shared decision making

  • 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

  • We suggest TMP-SMX rather than clindamycin because TMP-SMX has a lower risk of diarrhoea

  • Cephalosporins in addition to incision and drainage are probably not more effective than incision and drainage alone in most settings

  • From a societal perspective, the modest benefits from adjuvant antibiotics may not outweigh the harms from increased antimicrobial resistance in the community, although this is speculative

For further reference log on to :

BMJ 2018360 doi:

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  1. user
    Prof. Haribhai L. Patel February 11, 2018, 5:43 pm

    In uncomplicated abscess, sufficiently long incision and drainage WITHOUT ANTIBIOTICS is the correct treatment. Hot fomentation once or twice a day will hasten healing. I have been practising for more than 65 years and have persistent excellent results. When we have been facing septicaemia deaths due to resistant bacteria (last para of the paper) we must take every step to counteract. In fact, I have been teaching my UG and PG students on this line. It seems the article is under influence of vested interests. Let us help the society remain healthy. Prof. Haribhai L. Patel, Ahmadabad, India. 11 Feb 2018

  2. One more fine point regarding my technique on abscesses. There is some bleeding or oozing that is easily controlled by pressure in between. Suction drain itself acts as tampon too by coapting the abscess walls.

  3. This is a highly debatable issue of pyogenic abscesses, anywhere in body including few especial sites, e.g., breast, ischiorectal abscesses, etc. My own practice is, wait to start antibiotic unless there are systemic toxic effects like signs of pyemia or SIRS, etc and let the pus form, lest it neither suppurate nor resolve or worst, form an antibioma. After pus has formed, I make a small I/D, currette the abscess wall of its slough, place a suction drain and give appropriate antibiotics. Treat it like any other surgical condition for removal of drain and post op care. It has given me consistent good results and have received patients from far and wide.