antibiotics

Major modifiable risk factors for childhood food allergies include delayed introduction of solid foods and early treatment with antibiotics. James W. Mold, MD, MPH

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Importance: The incidence and risk (predictive) factors for early life food allergy development remain uncertain.

Objective: To estimate the incidence and quantify risk factors for food allergy development.

Data sources: MEDLINE and Embase were systematically searched to January 1, 2025. Data were analyzed from June 1, 2025, to November 25, 2025.

Study selection: Incidence estimates included studies confirming food allergy via food challenge. Risk factor analyses included cohort, case-control, and cross-sectional studies in any language assessing children younger than 6 years using multivariable analyses.

Data extraction and synthesis: Paired reviewers independently extracted data. Random-effects meta-analyses pooled incidence and adjusted odds ratios (ORs). Risk of bias was assessed using the QUIPS tool, and certainty of evidence assessed using GRADE.

Main outcome and measure: The primary outcome was food allergy to age 6 years.

Results: A total of 190 studies involving 2.8 million participants across 40 countries were analyzed. Among studies using food challenge, overall food allergy incidence was likely 4.7% (moderate certainty). Among 176 studies identifying 342 risk factors with varying certainty, the strongest and most certain factors included prior allergic conditions (eg, atopic dermatitis [eczema] within the first year of life [OR, 3.88; risk difference [RD], 12.0%; 95% CI, 8.8%-15.7%], allergic rhinitis [OR, 3.39; RD, 10.1%; 95% CI, 6.7%-14.4%], and wheeze [OR, 2.11; RD, 5.0%; 95% CI, 2.1%-8.8%]), severity of atopic dermatitis (OR, 1.22; RD, 1.0%; 95% CI, 0.6%-1.6%), increased skin transepidermal water loss (OR, 3.36; RD, 10.0%; 95% CI, 6.3%-14.8%), filaggrin gene sequence variations (OR, 1.93; RD, 4.2%; 95% CI, 2.4%-6.4%), delayed solid food introduction (eg, peanut after age 12 months [OR, 2.55; RD, 6.8%; 95% CI, 1.9%-14.6%]), infant antibiotic use (first month [OR, 4.11; RD, 12.8%; 95% CI, 0.4%-40%], first year [OR, 1.39; RD, 1.8%; 95% CI, 0.8%-3.1%], during pregnancy [OR, 1.32; RD, 1.5%; 95% CI, 0.6%-2.5%]), male sex (OR, 1.24; RD, 1.1%; 95% CI, 0.7%-1.6%), firstborn child (OR, 1.13; RD, 0.6%; 95% CI, 0.3%-1.0%), family history of food allergy (eg, mother [OR, 1.98; RD, 4.4%; 95% CI, 2.5%-6.8%], father [OR, 1.69; RD, 3.2%; 95% CI, 1.3%-5.5%], both parents [OR, 2.07; RD, 4.8%; 95% CI, 1.3%-5.5%], siblings [OR, 2.36; RD, 6.0%; 95% CI, 4.4%-8.0%]), parental migration (OR, 3.28; RD, 9.7%; 95% CI, 4.9%-16.3%), self-identification as Black (vs White [OR, 3.93; RD, 12.1%; 95% CI, 5.2%-22.5%], vs non-Hispanic White [OR, 2.23; RD, 5.5%; 95% CI, 3.0%-8.7%]), and cesarean delivery (OR, 1.16; RD, 1.0%; 95% CI, 0.3%-1.2%). Factors like low birth weight, postterm birth, maternal diet, and stress during pregnancy showed no significant risk difference.

Conclusions and relevance: In this meta-analysis, the most credible risk factors associated with development of childhood food allergy are a combination of major and minor risk factors, including early allergic conditions (atopic march/diathesis), delayed allergen introduction, genetics, antibiotic exposure, demographic factors, and birth-related variables.

Author/s:

Nazmul Islam, Alexandro W L Chu, Falana Sheriff, Farid Foroutan, Gordon H Guyatt, Romina Brignardello-Petersen, Paul Oykhman, Alfonso Iorio, Ariel Izcovich, Katherine M Morrison, Yetiani Roldan Benitez

Antibiotics for acute diverticulitis

Erin Blanchette — Wed, 02 Apr 2025 21:42:20 +0000

Date Added:

April 2, 2025

Journal/Publication:

Canadian Family Physician

Publisher:

College of Family Physicians of Canada

Publication Date:

March 1, 2025

Issue:

Volume:

Pages:

184

URL:

Antibiotics for acute diverticulitis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.7103184

Keywords

PMID (1):

40102007

MeSH

Diverticulitis

anti-bacterial agents

Frail Elderly

Colorectal Neoplasms

A concise summary of the evidence regarding treatment of acute diverticulitis with antibiotics. James W. Mold, MD, MPH

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Clinical question: Do antibiotics change clinical outcomes for patients with acute uncomplicated diverticulitis?
Bottom line: For nonseptic immunocompetent patients with acute uncomplicated diverticulitis, antibiotics do not alter early complication or recurrence rates.

Author/s:

Michael R Kolber, Clarence K Wong

Evaluation of Suspected Antibiotic Allergies

Erin Blanchette — Mon, 16 Sep 2024 13:43:25 +0000

Date Added:

September 16, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

September 11, 2024

URL:

Evaluation of Suspected Antibiotic Allergies

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.14143

Keywords

Anaphylaxis

antibiotics

antibiotic allergies

PMID (1):

39259567

MeSH

Anaphylaxis

Immune Checkpoint Inhibitors

anti-bacterial agents

Anti-Bacterial Agents / adverse effects

Drug Hypersensitivity

RPR Commentary: A CPG for management of patients with a history of allergy to antibiotics. James W. Mold, MD, MPH

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Antibiotic-associated adverse drug reactions are often mild (eg, nausea or diarrhea) and typically occur 1 to 6 hours after drug exposure. IgE-mediated reactions cause urticaria, angioedema, bronchospasm, or, in severe cases, anaphylaxis. Cell-mediated delayed hypersensitivity can occur over days to weeks, most commonly as benign cutaneous morbilliform eruptions, although more severe manifestations, such as Stevens-Johnson syndrome, may occur.

The guideline provides evidence-based recommendations for evaluating possible drug allergy in nonsteroidal anti-inflammatory drugs, chemotherapies, immune checkpoint inhibitors, biologic agents, and excipients (inactive substances formulated with pharmaceuticals). This JAMA Clinical Guidelines Synopsis focuses on practice recommendations for antibiotic allergy evaluation.

Author/s:

Ruchi Singla, Megan C Elios, Andrew M Davis

A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis

Devin Evans — Thu, 10 Sep 2020 05:00:00 +0000

Date Added:

October 9, 2020

Journal/Publication:

The New England Journal of Medicine

Publication Date:

October 5, 2020

URL:

A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa2014320

Keywords

PMID (1):

33017106

MeSH

Appendectomy

Appendicitis

anti-bacterial agents

Laparoscopy

This looks like the definitive short-term RCT on antibiotics vs. appendectomy for appendicitis. Antibiotics were “non-inferior.” However, 3/10 patients required appendectomy within 90 days. James W. Mold, MD, MPH

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BACKGROUND

Antibiotic therapy has been proposed as an alternative to surgery for the treatment of appendicitis.

METHODS

We conducted a pragmatic, nonblinded, noninferiority, randomized trial comparing antibiotic therapy (10-day course) with appendectomy in patients with appendicitis at 25 U.S. centers. The primary outcome was 30-day health status, as assessed with the European Quality of Life–5 Dimensions (EQ-5D) questionnaire (scores range from 0 to 1, with higher scores indicating better health status; noninferiority margin, 0.05 points). Secondary outcomes included appendectomy in the antibiotics group and complications through 90 days; analyses were prespecified in subgroups defined according to the presence or absence of an appendicolith.

RESULTS

In total, 1552 adults (414 with an appendicolith) underwent randomization; 776 were assigned to receive antibiotics (47% of whom were not hospitalized for the index treatment) and 776 to undergo appendectomy (96% of whom underwent a laparoscopic procedure). Antibiotics were noninferior to appendectomy on the basis of 30-day EQ-5D scores (mean difference, 0.01 points; 95% confidence interval [CI], −0.001 to 0.03). In the antibiotics group, 29% had undergone appendectomy by 90 days, including 41% of those with an appendicolith and 25% of those without an appendicolith. Complications were more common in the antibiotics group than in the appendectomy group (8.1 vs. 3.5 per 100 participants; rate ratio, 2.28; 95% CI, 1.30 to 3.98); the higher rate in the antibiotics group could be attributed to those with an appendicolith (20.2 vs. 3.6 per 100 participants; rate ratio, 5.69; 95% CI, 2.11 to 15.38) and not to those without an appendicolith (3.7 vs. 3.5 per 100 participants; rate ratio, 1.05; 95% CI, 0.45 to 2.43). The rate of serious adverse events was 4.0 per 100 participants in the antibiotics group and 3.0 per 100 participants in the appendectomy group (rate ratio, 1.29; 95% CI, 0.67 to 2.50).

CONCLUSIONS

For the treatment of appendicitis, antibiotics were noninferior to appendectomy on the basis of results of a standard health-status measure. In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith.

Author/s:

CODA Collaborative, Flum, David R., Davidson, Giana H., Monsell, Sarah E., Shapiro, Nathan I., Odom, Stephen R., Sanchez, Sabrina E., Drake, F.T., Fischkoff, Katherine, Johnson, Jeffrey, Patton, Joe H., Evans, Heather, Cuschieri, Joseph, Sabbatini, Amber K., Faine, Brett A., Skeete, Dionne A., Liang, Mike K., Sohn, Vance, McGrane, Karen", Matthew E., Chung, Bruce, Carter, Damien W., Ayoung-Chee, Patricia, Chiang, William, Rushing, Amy, Steinberg, Steven, Foster, Careen S., Schaetzel, Shaina M., Price, Thea P., Mandell, Kathrine A., Ferrigno, Lisa, Salzberg, Matthew, DeUgarte, Daniel A., Kaji, Amy H., Moran, Gregory J., Saltzman, Darin, Alam, Hasan B., Park, Pauline K., Kao, Lilian S., Thompson, Callie M., Self, Wesley H., Yu, Julianna T., Wiebusch, Abigail, Winchell, Robert J., Clark, Sunday, Krishnadasan, Anusha, Fannon, Erin, Lavallee, Danielle C., Comstock, Bryan A., Bizzell, Bonnie, Heagerty, Patrick J., Kessler, Larry G., Talan, David A.

Antibiotic Resistance Threats in the United States, 2019

John Bayhi — Fri, 06 Dec 2019 16:26:39 +0000

Date Added:

December 6, 2019

Publisher:

U.S. Department of Health and Human Services

Publication Date:

December 1, 2019

URL:

Antibiotic Resistance Threats in the United States, 2019

Type:

Public Health Announcements

Format:

Article

Keywords

antibiotics

antibiotic resistance

clostridium difficile

candida auris

acinetobacter

Enterobacteriaceae

neisseria gonorrhoeae

This CDC resource provides links to information on organisms that have developed resistance to first-line antibiotics.

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CDC’s Antibiotic Resistance Threats in the United States, 2019 (2019 AR Threats Report) includes the latest national death and infection estimates that underscore the continued threat of antibiotic resistance in the U.S.

According to the report, more than 2.8 million antibiotic-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result. In addition, 223,900 cases of Clostridioides difficile occurred in 2017 and at least 12,800 people died.

Dedicated prevention and infection control efforts in the U.S. are working to reduce the number of infections and deaths caused by antibiotic-resistant germs, but the number of people facing antibiotic resistance is still too high. More action is needed to fully protect people.

CDC is concerned about rising resistant infections in the community, which can put more people at risk, make spread more difficult to identify and contain, and threaten the progress made to protect patients in healthcare. The emergence and spread of new forms of resistance remains a concern.

The report lists 18 antibiotic-resistant bacteria and fungi into three categories based on level of concern to human health—urgent, serious, and concerning—and highlights:

Estimated infections and deaths since the 2013 report
Aggressive actions taken
Gaps slowing progress

The report also includes a Watch List with three threats that have not spread resistance widely in the U.S. but could become common without a continued aggressive approach.

Author/s:

Center for Disease Control and Prevention

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations

John Bayhi — Thu, 11 Jul 2019 19:47:05 +0000

Date Added:

July 11, 2019

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

July 11, 2019

Issue:

Volume:

381

Pages:

111-120

URL:

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa1803185

Keywords

C-reactive protein

primary care

chronic obstructive pulmonary disease

copd

CRP

randomized control trial

antibiotics

PMID (1):

31291514

MeSH

Point-Of-Care Testing

anti-bacterial agents

technology assessment, biomedical

Wales

follow-up studies

random allocation

pulmonary disease, chronic obstructive

health status

Surveys and Questionnaires

primary health care

referral and consultation

England

In adults with acute COPD exacerbations, serum CRP-based decision-making led to fewer antibiotic prescriptions with no adverse consequences. Physicians and patients in the intervention group were advised to consider all clinically relevant information. However, they were advised to consider that CRP levels < 4omg/L indicated that antibiotics were probably not needed, levels between 20 and 40 mg/L were indeterminant, and levels above 40 mg/L suggested that antibiotics were probably necessary. Note: In this study, physicians were able to obtain CRP levels at the point of care. James W. Mold, MD, MPH

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BACKGROUND

Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD).

METHODS

We performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD in their primary care clinical record who consulted a clinician at 1 of 86 general medical practices in England and Wales for an acute exacerbation of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging from 0 (very good COPD health status) to 6 (extremely poor COPD health status) (to show noninferiority).

RESULTS

A total of 653 patients underwent randomization. Fewer patients in the CRP-guided group reported antibiotic use than in the usual-care group (57.0% vs. 77.4%; adjusted odds ratio, 0.31; 95% confidence interval [CI], 0.20 to 0.47). The adjusted mean difference in the total score on the Clinical COPD Questionnaire at 2 weeks was −0.19 points (two-sided 90% CI, −0.33 to −0.05) in favor of the CRP-guided group. The antibiotic prescribing decisions made by clinicians at the initial consultation were ascertained for all but 1 patient, and antibiotic prescriptions issued over the first 4 weeks of follow-up were ascertained for 96.9% of the patients. A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of follow-up (59.1% vs. 79.7%, for a difference of 20.6 percentage points; adjusted odds ratio, 0.30; 95% CI, 0.20 to 0.46). Two patients in the usual-care group died within 4 weeks after randomization from causes considered by the investigators to be unrelated to trial participation.

CONCLUSIONS

CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm. (Funded by the National Institute for Health Research Health Technology Assessment Program; PACE Current Controlled Trials number, ISRCTN24346473.)

Author/s:

Butler, Christopher C., Gillespie, David, White, Patrick, Bates, Janine, Lowe, Rachel, Thomas-Jones, Emma, Wootton, Mandy, Hood, Kerenza, Phillips, Rhiannon, Melbye, M., Llor, Carl, Cals, Jochen W.L.

Grommets (ventilation tubes) for recurrent acute otitis media in children

Brian Desmarais — Thu, 23 May 2019 13:35:27 +0000

Date Added:

May 23, 2019

Journal/Publication:

The Cochrane Database of Systematic Reviews

Publication Date:

May 9, 2018

URL:

Grommets (ventilation tubes) for recurrent acute otitis media in children

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD012017.pub2

Keywords

MeSH

Middle Ear Ventilation

Otitis Media with Effusion

Odds Ratio

anti-bacterial agents

Tympanic Membrane Perforation

Antibiotic Prophylaxis

PE tube insertion in children with recurrent AOM may reduce the number of episodes of AOM but not by much. James W. Mold, MD, MPH

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BACKGROUND:

Acute otitis media (AOM) is one of the most common childhood illnesses. While many children experience sporadic AOM episodes, an important group suffer from recurrent AOM (rAOM), defined as three or more episodes in six months, or four or more in one year. In this subset of children AOM poses a true burden through frequent episodes of ear pain, general illness, sleepless nights and time lost from nursery or school. Grommets, also called ventilation or tympanostomy tubes, can be offered for rAOM.

OBJECTIVES:

To assess the benefits and harms of bilateral grommet insertion with or without concurrent adenoidectomy in children with rAOM.

SEARCH METHODS:

The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; CENTRAL; MEDLINE; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 4 December 2017.

SELECTION CRITERIA:

Randomised controlled trials (RCTs) comparing bilateral grommet insertion with or without concurrent adenoidectomy and no ear surgery in children up to age 16 years with rAOM. We planned to apply two main scenarios: grommets as a single surgical intervention and grommets as concurrent treatment with adenoidectomy (i.e. children in both the intervention and comparator groups underwent adenoidectomy). The comparators included active monitoring, antibiotic prophylaxis and placebo medication.

DATA COLLECTION AND ANALYSIS:

We used the standard methodological procedures expected by Cochrane. Primary outcomes were: proportion of children who have no AOM recurrences at three to six months follow-up (intermediate-term) and persistent tympanic membrane perforation (significant adverse event). Secondary outcomes were: proportion of children who have no AOM recurrences at six to 12 months follow-up (long-term); total number of AOM recurrences, disease-specific and generic health-related quality of life, presence of middle ear effusion and other adverse events at short-term, intermediate-term and long-term follow-up. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.

MAIN RESULTS:

Five RCTs (805 children) with unclear or high risk of bias were included. All studies were conducted prior to the introduction of pneumococcal vaccination in the countries' national immunisation programmes. In none of the trials was adenoidectomy performed concurrently in both groups.Grommets versus active monitoringGrommets were more effective than active monitoring in terms of:- proportion of children who had no AOM recurrence at six months (one study, 95 children, 46% versus 5%; risk ratio (RR) 9.49, 95% confidence interval (CI) 2.38 to 37.80, number needed to treat to benefit (NNTB) 3; low-quality evidence);- proportion of children who had no AOM recurrence at 12 months (one study, 200 children, 48% versus 34%; RR 1.41, 95% CI 1.00 to 1.99, NNTB 8; low-quality evidence);- number of AOM recurrences at six months (one study, 95 children, mean number of AOM recurrences per child: 0.67 versus 2.17, mean difference (MD) -1.50, 95% CI -1.99 to -1.01; low-quality evidence);- number of AOM recurrences at 12 months (one study, 200 children, one-year AOM incidence rate: 1.15 versus 1.70, incidence rate difference -0.55, 95% -0.17 to -0.93; low-quality evidence).Children receiving grommets did not have better disease-specific health-related quality of life (Otitis Media-6 questionnaire) at four (one study, 85 children) or 12 months (one study, 81 children) than those managed by active monitoring (low-quality evidence).One study reported no persistent tympanic membrane perforations among 54 children receiving grommets (low-quality evidence).Grommets versus antibiotic prophylaxisIt is uncertain whether or not grommets are more effective than antibiotic prophylaxis in terms of:- proportion of children who had no AOM recurrence at six months (two studies, 96 children, 60% versus 35%; RR 1.68, 95% CI 1.07 to 2.65, I2 = 0%, fixed-effect model, NNTB 5; very low-quality evidence);- number of AOM recurrences at six months (one study, 43 children, mean number of AOM recurrences per child: 0.86 versus 1.38, MD -0.52, 95% CI -1.37 to 0.33; very low-quality evidence).Grommets versus placebo medicationGrommets were more effective than placebo medication in terms of:- proportion of children who had no AOM recurrence at six months (one study, 42 children, 55% versus 15%; RR 3.64, 95% CI 1.20 to 11.04, NNTB 3; very low-quality evidence);- number of AOM recurrences at six months (one study, 42 children, mean number of AOM recurrences per child: 0.86 versus 2.0, MD -1.14, 95% CI -2.06 to -0.22; very low-quality evidence).One study reported persistent tympanic membrane perforations in 3 of 76 children (4%) receiving grommets (low-quality evidence).Subgroup analysisThere were insufficient data to determine whether presence of middle ear effusion at randomisation, type of grommet or age modified the effectiveness of grommets.

AUTHORS' CONCLUSIONS:

Current evidence on the effectiveness of grommets in children with rAOM is limited to five RCTs with unclear or high risk of bias, which were conducted prior to the introduction of pneumococcal vaccination. Low to very low-quality evidence suggests that children receiving grommets are less likely to have AOM recurrences compared to those managed by active monitoring and placebo medication, but the magnitude of the effect is modest with around one fewer episode at six months and a less noticeable effect by 12 months. The low to very low quality of the evidence means that these numbers need to be interpreted with caution since the true effects may be substantially different. It is uncertain whether or not grommets are more effective than antibiotic prophylaxis. The risk of persistent tympanic membrane perforation after grommet insertion was low.Widespread use of pneumococcal vaccination has changed the bacteriology and epidemiology of AOM, and how this might impact the results of prior trials is unknown. New and high-quality RCTs of grommet insertion in children with rAOM are therefore needed. These trials should not only focus on the frequency of AOM recurrences, but also collect data on the severity of AOM episodes, antibiotic consumption and adverse effects of both surgery and antibiotics. This is particularly important since grommets may reduce the severity of AOM recurrences and allow for topical rather than oral antibiotic treatment.

Author/s:

A.G., Mick, P., Venekamp, R.P.

Chapter 16: Pertussis

Tracy Ashby — Fri, 07 Dec 2018 06:00:00 +0000

Date Added:

December 7, 2018

Journal/Publication:

Epidemiology and Prevention of Vaccine-Preventable Diseases, aka "Pink Book"

Publisher:

Centers for Disease Control and Prevention

Publication Date:

January 1, 2015

Pages:

261-278

URL:

Epidemiology and Prevention of Vaccine-Preventable Diseases

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Keywords

MeSH

trimethoprim, sulfamethoxazole drug combination

This is a chapter on Bordetella pertussis from the Pink Book on infectious diseases. Several key points regarding pertussis in adults:

Immunization is not 100% effective but usually diminishes disease severity
In immunized adults, pertussis causes URI symptoms plus cough that can last for weeks
Antibiotics (macrolides or Bactrim) reduce contagion but have little effect on symptoms

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Pertussis, or whooping cough, is an acute infectious disease caused by the bacterium Bordetella pertussis. Outbreaks of pertussis were first described in the 16th century, and the organism was first isolated in 1906.

In the 20th century, pertussis was one of the most common childhood diseases and a major cause of childhood mortality in the United States. Before the availability of pertussis vaccine in the 1940s, more than 200,000 cases of pertussis were reported annually. Since widespread use of the vaccine began, incidence has decreased more than 80% compared with the prevaccine era.

Pertussis remains a major health problem among children in developing countries, with 195,000 deaths resulting from the disease in 2008 (World Health Organization estimate).

Author/s:

Hamborsky, Jennifer, Kroger, Andrew, Wolfe, Charles S.

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

Jeffrey Wilson — Thu, 23 Aug 2018 16:46:00 +0000

Date Added:

September 29, 2018

Journal/Publication:

The BMJ

Publisher:

BMJ

Publication Date:

February 6, 2018

Issue:

360

URL:

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

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1136/bmj.k243

Keywords

PMID (1):

29437651

MeSH

trimethoprim, sulfamethoxazole drug combination

drug resistance, bacterial

anti-bacterial agents

abscess

drainage

clindamycin

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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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

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.