Antibiotic Treatment Duration Following Skin Abscess Drainage

November 18, 2015

Antibiotic Treatment Duration Following Skin Abscess Drainage

  1. Deborah Lehman, MD

Ten days is better than 3 days to prevent recurrences in infections caused by MRSA.

  1. Deborah Lehman, MD

Staphylococcus aureus, both methicillin-sensitive (MSSA) and methicillin-resistant (MRSA), causes the majority of skin and soft tissue infections in adults and children. Incision and drainage (I&D) is the mainstay of therapy for uncomplicated skin abscesses (NEJM JW Gen Med Oct 14 2010 and Ann Emerg Med 2010; 56:283), but the optimal duration of antibiotic therapy, if prescribed following I&D, has not been determined.

In the current study, children aged 3 months to 17 years presenting to a single pediatric emergency department with uncomplicated skin abscesses were randomly assigned to either a 3-day or 10-day course of trimethoprim-sulfamethoxazole following abscess I&D. More children in the 10-day group had evidence of cellulitis and received an intravenous dose of clindamycin prior to discharge from the emergency department. S. aureus was isolated from 87% of the cultures (64% MRSA and 36% MSSA), all susceptible to trimethoprim-sulfamethoxazole.

Treatment failure overall was 5% and did not differ between the two study groups, but in those patients with S. aureus, the failure rate was higher in those receiving 3 days versus 10 days of antibiotics (rate difference 6.5%), and failure risk was highest in those with MRSA (rate difference, 10.1%). Recurrence of infection during the next month was higher in patients treated with 3 days versus 10 days of antibiotics (rate difference, 10.7%) even after adjusting for the receipt of clindamycin.

Comment

Following incision and drainage for uncomplicated skin abscesses, overall treatment failure was low, and for most children an additional week of antibiotics is not warranted. However, in children with either known or suspected MRSA infection, these data suggest that a 10-day course of antibiotics is more effective than a 3-day course and reduces short-term recurrence risk.

Editor Disclosures at Time of Publication

  • Disclosures for Deborah Lehman, MD at time of publication Leadership positions in professional societies AAP PREP: The Course Planning Committee

Citation(s):

Reader Comments (1)

Steven Holtzman, MD Physician, Surgery, General

Most studies have shown that a zero day course of antibiotics after I&D in children with uncomplicated cutaneous abscess are effective. NEJM 379:1039, 2014

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