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Diagnosis and Management of Infectious Diarrhea

Author/s: 
Hamilton, Keith W., Cifu, Adam S.

Infectious diarrhea is the fifth leading cause of death worldwide. In the United States, 179 million cases of acute diarrhea occur per year. Most diarrheal illnesses are self-limited and do not require evaluation or treatment beyond supportive care such as rehydration. Some infections do require antimicrobial therapy, and appropriate use of diagnostic tests and treatments may potentially minimize unnecessary costs, decrease adverse events, optimize clinical outcomes, and limit antibiotic resistance.

Keywords 
infectious diarrhea stool testing

Antibiotics After Incision and Drainage for Uncomplicated Skin Abscesses: A Clinical Practice Guide

Author/s: 
Vermandere, Mieke, Aertgeerts, Bert, Agoritsas, Thomas, Liu, Catherine, Burgers, Jako, Merglen, Arnaud, Okwen, Patrick Mbah, Lytvyn, Lyubov, Chua, Shunjie, Vandvik, Per O., Guyatt, Gordon H., Beltran-Arroyave, Claudia, Lavergne, Valéry, Speeckaert, Reinhart, Steen, Finn E., Arteaga, Victoria, Sender, Rachelle, McLeod, Shelley, Sun, Xin, Wang, Wen, Siemieniuk, Reed A.C.

What you need to know

  • For uncomplicated skin abscesses, we suggest using trimethoprim-sulfamethoxazole (TMP-SMX) or clindamycin in addition to incision and drainage rather than incision and drainage alone, and emphasise the need for shared decision making

  • TMP-SMX or clindamycin modestly reduces pain and treatment failure and probably reduces abscess recurrence, but increases the risk of adverse effects including nausea and diarrhoea

  • We suggest TMP-SMX rather than clindamycin because TMP-SMX has a lower risk of diarrhoea

  • Cephalosporins in addition to incision and drainage are probably not more effective than incision and drainage alone in most settings

  • From a societal perspective, the modest benefits from adjuvant antibiotics may not outweigh the harms from increased antimicrobial resistance in the community, although this is speculative

Keywords 
abscess drainage antibiotics TMP-SMX clindamycin
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