Antibiotics improve short-term outcomes in small skin abscesses

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Clindamycin or TMP-SMX in conjunction with incision and drainage improved short-term outcomes compared with incision and drainage alone.
Clindamycin or TMP-SMX in conjunction with incision and drainage improved short-term outcomes compared with incision and drainage alone.

Patients with a simple abscess who received clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) in addition to incision and drainage had improved short-term outcomes compared with those who received incision and drainage alone, according to data published in the New England Journal of Medicine.

Robert S. Daum, MD, CM, from the University of Chicago Hospitals, and colleagues conducted a multicenter, prospective, double-blind trial that included 786 outpatient adults and children who had a skin abscess smaller than 5 cm in diameter.

The participants were stratified according to the presence of a surgically drainable abscess, abscess size, number of sites of skin infection, and the presence of nonpurulent cellulitis. They were randomly assigned to receive clindamycin, TMP-SMX, or placebo for 10 days after abscess incision and drainage.

S. aureus was isolated from 67.0% of participants, and methicillin-resistant Staphylococcus aureus (MRSA) was isolated from 49.4% of participants. After 10 days of therapy, the cure rate among participants receiving clindamycin was 83.1% compared with 81.7% among those receiving TMP-SMX. The cure rate in both groups was higher than that in the placebo group (68.9%).

Among the participants who were initially cured, 6.8% of participants in the clindamycin group had a new infection at the 1-month follow-up, compared with 13.5% of participants in the TMP-SMX group and 12.4% of participants in the placebo group.

The investigators note that adverse events were more common in the clindamycin group (21.9%) than in the TMP-SMX group (11.1%) or in the placebo group (12.5%). All adverse events resolved with sequelae, and one participant who received TMP-SMX had a hypersensitivity reaction.

“Our results show that short-term outcomes among patients with uncomplicated cutaneous abscesses, particularly those caused by S. aureus, are improved by antibiotic treatment with either clindamycin or TMP-SMX in addition to abscess incision and drainage,” the researchers concluded.

Reference

  1. Daum RS, Miller LG, Immergluck L, et al. A placebo-controlled trial of antibiotics for smaller skin abscesses. N Engl J Med. 2017;376:2545-2555. doi:10.1056/NEJMoa1607033
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