Monday, April 2, 2018

Abscess Management

R.E.B.E.L.EM - April 02, 2018 - 
Ref: Gottlieb M et al. Systemic Antibiotics for the Treatment of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-Analysis. Ann Emerg Med 2018. [Epub Ahead of Print]
"Background: Skin and soft tissue abscesses are a common emergency department (ED) presentation. The approach to management has changed little in recent decades: incision and drainage (I+D) and then discharge home with follow up. However, increasing rates of methicillin-resistant staph aureus (MRSA) over the last decade have led to further consideration of adjunct therapy with oral antibiotics to improve cure rates. Two recent studies (Talan 2016, Daum 2017) have shown a modest but consistent benefit to oral antibiotics...
Potential to Impact Current Practice: The findings of this systematic review and meta-analysis show strong evidence that antibiotic therapy, in addition to I&D, leads to higher cure rates for small abscesses with overlying cellulitis. These findings should not be taken to mean that all patients with abscesses who are I&D’d in the ED will need antibiotics as the majority of abscesses (84%) will resolve with I&D alone. The increased clinical cure rate must be weighed against the potential risks associated with increase antibiotic use such as adverse medication-related events and increasing antibiotic resistance.
Bottom Line: ED providers should consider adjunctive therapy with oral antibiotics with MRSA coverage after I&D of simple, small (<5cm) abscesses with overlying cellulitis in healthy individuals to increase short-term cure rates. The presence of significant overlying cellulitis continues to warrant adjunctive therapy with antibiotics."