Download Are Antibiotics Needed after Incision and Drainage for Treatment of Pediatric Skin Abscesses?

Are Antibiotics Needed after Incision and Drainage for
Treatment of Pediatric Skin Abscesses?
Jason Pryor MD and Nilesh Dankhara
Date of Initial Appraisal: 1/8/13
Clinical Question: Does the addition of systemic antibiotics improve outcomes in
pediatric patients with skin abscesses following incision and drainage.
Clinical Bottom Line
1. In a double-blinded, prospective, RCT of 161 pediatric patients, findings do
not support the use of antibiotics as an adjuvant therapy to incision and
drainage for pediatric skin abscesses.
2. 5.3% of the placebo group had treatment failure which was comparable to
the 4.1% in the treatment group.
3. New lesion development was significantly higher at 10 day follow-up in the
placebo group.
Evidence Summary
1. 161 pediatric patients ranging from 3 months to 18 years of age were
enrolled in the study.
2. Exclusion Criteria: Chronic health problems, patients on immunosuppressive
medications, antibiotic therapy currently or within one week of possible
study enrollment, contraindication to TMP/SMX.
3. Participants were randomly assigned to either placebo for 10 days or 10 days
of TMP/SMX following incision and drainage. Follow-up was performed at 10
and 90 days.
4. Primary measure was symptomatic treatment failure. Secondary measure
was the development of new lesions at 10 and 90 day follow-up.
5. Of the 161 patients enrolled, 149 completed the trial. Compliance was 66%
and was defined as completing at least 50% of the medication at 10 day
follow-up.
6. The placebo group had a comparable failure rate to the treatment group.
(5.4% vs 4.1%)
7. There was significantly higher incidence of new abscess formation in the
placebo group compared to the treatment group (19 vs 9).
Comments
1. Reported to be the first published RCT evaluating the benefits of antibiotic
therapy of adequately drained skin abscesses in the era of CA-MRSA.12
2. Limitations to the study include: possible selection bias due to many
potential patients not being enrolled, 40% of the follow-up at 10 days was via
phone call, 40% of patients were lost to follow-up at 90 days, and the
designated cutoff for statistical treatment failure was 7%.
3. This study shows that antibiotics are not required for pediatric abscess
resolution. Antibiotics may help prevent new lesions in the short term, but
further studies are required.1,2
References
1. Rajendran P, Young D, Maurer T, et al. Randomized, double-blind, placebocontrolled trial of cephalexin for treatment of uncomplicated skin abscesses
in a population at risk of community-acquired methicillin-resistant
Staphylococcus aureus infection. Antimicrob Agents Chemother.
2007;55:4044-4048.
2. Duong M, Markwell D, et al. Randomized, Controlled Trial of Antibiotics in the
Management of Community-Acquired Skin Abscesses in the Pediatric Patient.
Annals of Emergency Medicine. 2010;55:401-407.