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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.