Gottlieb M, DeMott JM, Hallock M, Peksa GD, et al.
Annals of emergency medicine. Date of publication 2019 Jan 1;volume 73(1):8-16.
1. Ann Emerg Med. 2019 Jan;73(1):8-16. doi: 10.1016/j.annemergmed.2018.02.011.
Epub 2018 Mar 9.
Systemic Antibiotics for the Treatment of Skin and Soft Tissue Abscesses:
A Systematic Review and Meta-Analysis.
Gottlieb M(1), DeMott JM(2), Hallock M(2), Peksa GD(2).
Author information:
(1)Department of Emergency Medicine, Rush University Medical Center, Chicago,
IL. Electronic address: michaelgottliebmd@gmail.com.
(2)Department of Emergency Medicine, Rush University Medical Center, Chicago,
IL.
Comment in
CJEM. 2020 Jan;22(1):27-28.
STUDY OBJECTIVE: The addition of antibiotics to standard incision and drainage
is controversial, with earlier studies demonstrating no significant benefit.
However, 2 large, multicenter trials have recently been published that have
challenged the previous literature. The goal of this review was to determine
whether systemic antibiotics for abscesses after incision and drainage improve
cure rates.
METHODS: PubMed, the Cumulative Index of Nursing and Allied Health Literature,
Scopus, the Cochrane Database of Systematic Reviews, the Cochrane Central
Register of Controlled Trials, and bibliographies of selected articles were
assessed for all randomized controlled trials comparing adjuvant antibiotics
with placebo in the treatment of drained abscesses, with an outcome of treatment
failure assessed within 21 days. Data were dual extracted into a predefined
worksheet and quality analysis was performed with the Cochrane Risk of Bias
tool.
RESULTS: Four studies (n=2,406 participants) were identified. There were 89
treatment failures (7.7%) in the antibiotic group and 150 (16.1%) in the placebo
group. The calculated risk difference was 7.4% (95% confidence interval [CI]
2.8% to 12.1%), with an odds ratio for clinical cure of 2.32 (95% CI 1.75 to
3.08) in favor of the antibiotic group. There was also a decreased incidence of
new lesions in the antibiotic group (risk difference -10.0%, 95% CI -12.8% to
-7.2%; odds ratio 0.32, 95% CI 0.23 to 0.44), with a minimally increased risk of
minor adverse events (risk difference 4.4%, 95% CI 1.0% to 7.8%; odds ratio
1.29, 95% CI 1.06 to 1.58).
CONCLUSION: The use of systemic antibiotics for skin and soft tissue abscesses
after incision and drainage resulted in an increased rate of clinical cure.
Providers should consider the use of antibiotics while balancing the risk of
adverse events.
Copyright © 2018 American College of Emergency Physicians. Published by Elsevier
Inc. All rights reserved.
DOI: 10.1016/j.annemergmed.2018.02.011
PMID: 29530658 [Indexed for MEDLINE]
