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Clinician Article

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Antibiotics after incision and drainage for uncomplicated skin abscesses: a clinical practice guideline.

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• Vermandere M
• Aertgeerts B
• Agoritsas T
• Liu C
• Burgers J
• Merglen A, et al.

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Clinical Comments

Dermatology

Very disappointing article. It purports to be a guideline, yet uses patients on the panel to guide decisions. The overall recommendation was a "weak recommendation to use TMX/SMX for simple skin abscesses." Why? The authors acknowledge the risks for adverse effects including TEN, and the very small benefit shown by addition of antibiotics. Hence, the logical conclusion should have been to AVOID antibiotics for simple skin abscesses and just use drainage, except in the small number of severe cases or recurrences when antibiotics can be added. So, this is really a missed opportunity to provide proper guidance and leadership on this issue, which should have concluded to avoid antibiotics in most cases.

Emergency Medicine

Not sufficiently strong evidence to change practice.

Emergency Medicine

Most emergency physicians are aware of the findings.

Emergency Medicine

As an EM physician who sees patients with cutaneous abscesses on a daily basis, the decision whether to administer antibiotics is very important. This paper helps to clarify that issue while also stressing the use of shared decision-making.

Emergency Medicine

Tremendous work from the MAGICapp group. This is a great application of SRs and GRADE to what should be practice-changing information. Impressive as well is the clear and informative mode of presentation. A sound SR underlying this guideline is accessible to the clinician looking for more. What is not clear to me is how they gathered patient input.

Emergency Medicine

This along with the recent NEJM study (http://www.nejm.org/doi/full/10.1056/NEJMoa1607033) are near landmark papers on this important and common topic. Fully answers the long-asked question.

Family Medicine (FM)/General Practice (GP)

Succinct and useful summary that can help busy family doctors and their patients decide whether to initiate antibiotics after incision and drainage of a skin abscess, and which antibiotic to choose.

Infectious Disease

This article is a clear way to explain what is known about the confusing but common clinical question regarding whether to add antibiotics to incision and drainage of small subcutaneous abscesses. What makes it especially helpful is that it shows graphically how the authors got to their conclusions and is quite frank about the limitations of knowledge and the challenges of thinking epidemiologically about this individualized patient treatment decision. This is especially likely to help younger learners who need to have a working knowledge around this question and older clinicians who may not have been completely up to date regarding the prevalence of MRSA and the potential benefits vs. harms of short course oral antibiotics.

Internal Medicine

Even if this seems trivial, we hospitalists get this wrong >50%. We depend on Surgeons or ID given the unknown extent of the wound and relatively less experience with these cases. These guidelines make discharge planning easier. I am surprised to see that Bactrim is preferred over other drugs. In our practice, we tend to choose Clindamycin over Bactrim. There is an underlying dislike for Bactrim, specifically re AKI! Great to have guidelines. Transition to PO antibiotics and the initial choice of antibiotics in these scenarios is also helpful information.

Internal Medicine

A recent clinical trial prompted development of these guidelines, which were prepared in a timely fashion and in a usable format for clinicians as a point-of-care decision aid. A changing pattern of antibiotic resistance will likely change these guidelines in the future.

Pediatric Emergency Medicine

As an emergency physician that manages abscesses in both adults and paediatrics, this is an excellent review on the weak evidence about the value of adding antibiotics following incision and drainage for skin abscesses. This article takes a great patient-centred approach to the recommendations and provides some infographics that may be useful for shared decision-making.

Pediatric Emergency Medicine

Excellent synthesis of current evidence in abscess management. Many practitioners may not be aware of the level of evidence for arguments for and against antibiotics in abscesses after drainage, and may be choosing less appropriate antibiotics.

Pediatrics (General)

This is a nice review on the latest recommendations. However, it fails to address why clindamycin should be used if Staph is suspected. Most abscesses are caused by MSSA or MRSA and clindamycin need not be used especially where MRSA is high.

Pediatrics (General)

Excellent summary of current evidence in easily accessible format.