Consider Using TMP/SMX After Draining Uncomplicated Abscesses

March 2, 2016

Consider Using TMP/SMX After Draining Uncomplicated Abscesses

  1. Ali S. Raja, MD, MBA, MPH, FACEP

Trimethoprim–sulfamethoxazole led to a higher rate of cure, but even without antibiotics, the majority of abscesses resolved.

  1. Ali S. Raja, MD, MBA, MPH, FACEP

The appropriate treatment for uncomplicated cutaneous abscesses is incision and drainage. Thus far, studies have not shown any additional benefit from the administration of antibiotics. However, these studies may have been underpowered to detect the benefit of antibiotics, given that cure rates after drainage alone are high.

These investigators performed a double-blinded, randomized, controlled trial of trimethoprim–sulfamethoxazole (TMP/SMX; 320 mg/1600 mg, twice a day for 7 days) versus placebo in 1247 patients with uncomplicated abscesses that were detected by physical or ultrasonographic examination and were incised and drained. The primary outcome was clinical cure of the abscess, evaluated 1 to 2 weeks after the weeklong treatment course.

In a modified intention-to-treat analysis, the TMP/SMX group had a significantly higher rate of clinical cure (80.5% vs. 73.6%; P=0.005). In a per-protocol analysis of 1057 patients who completed at least 5 days of treatment and had an in-person follow-up visit, the difference had even greater statistical significance (92.9% vs. 85.7%; P<0.001). Patients in the TMP/SMX group had no serious adverse reactions to the medication.


It is notable that more than 85% of abscesses resolved after drainage alone; well-performed incision and drainage is still the cornerstone of management of uncomplicated abscesses. However, I will be sharing these results with my patients, and will prescribe the high-dose TMP/SMX used in this study for those who understand the potential gastrointestinal and other risks of the medication and desire a higher (but still not guaranteed) likelihood of cure.

Editor Disclosures at Time of Publication

  • Disclosures for Ali S. Raja, MD, MBA, MPH, FACEP at time of publication Speaker's bureau Airway Management Education Center Leadership positions in professional societies Society for Academic Emergency Medicine (Constitution and Bylaws Committee Chair, Program Committee Chair, and Trauma Interest Group Chair); American College of Emergency Physicians (Trauma and Injury Prevention Section Chair)


Reader Comments (1)

JOSE GROS-AYMERICH Physician, Family Medicine/General Practice, INSS retired
Competing Interests: Former employee of The Upjohn co (Spain), producers of Antibiotics

The precision: 'TMP-SMX after draining uncomplicated abscesses' seems specially appropriate. This combined drug act as an Anti-folate for bacteria, -sometimes also for humans, also for lice-, but purulent matter is rich in folates from broken dead cells, somehow or more, negating the action of SMX-TMP. Or not?

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