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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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