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

Treatment with TMP-SMX or clindamycin after incision and drainage modestly reduces pain and treatment failure and probably reduces abscess recurrence, but treatment increase the risk of adverse effects including nausea and diarrhea. Other antibiotics do not improve outcomes after I&D

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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

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.