A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses

Daum, Robert S.; Miller, Loren G.; Immergluck, Lilly Cheng; Fritz, Stephanie A.; Creech, C. Buddy; Young, David M.; Kumar, Neha; Downing, Michele; Pettibone, Stephanie; Hoagland, Rebecca; Eells, Samantha J.; Boyle, Mary G.; Parker, Trisha Chan; Chambers, Henry F.

doi:10.1056/nejmoa1607033

Cited by 169 publications

(130 citation statements)

References 17 publications

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“…There have been few prospective randomized trials exploring variations in the treatment of skin abscesses outside of antibiotics. The 2 most recent large randomized controlled trials on antibiotics and abscess drainage demonstrated a benefit from antibiotics, 11,12 but neither study included the use of ultrasonography as a possible confounder for its results. In the current study, antibiotic use was not associated with clinical cure.…”

Section: Discussionmentioning

confidence: 99%

Abscess Incision and Drainage With or Without Ultrasonography: A Randomized Controlled Trial

Gaspari

Sanseverino

Gleeson

2019

Annals of Emergency Medicine

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Study objective: We hypothesize that clinical failure rates will be lower in patients treated with point-of-care ultrasonography and incision and drainage compared with those who undergo incision and drainage after physical examination alone. Methods:We performed a prospective randomized clinical trial of patients presenting with a soft tissue abscess at a large, academic emergency department. Patients presenting with an uncomplicated soft tissue abscess requiring incision and drainage were eligible for enrollment and randomized to treatment with or without point-of-care ultrasonography. The diagnosis of an abscess was by physical examination, bedside ultrasonography, or both. Patients randomized to the point-of-care ultrasonography group had an incision and drainage performed with bedside ultrasonographic imaging of the abscess. Patients randomized to the non-pointof-care ultrasonography group had an incision and drainage performed with physical examination alone. Comparison between groups was by comparing means with 95% confidence intervals. The primary outcome was failure of therapy at 10 days, defined as a repeated incision and drainage, following a per-protocol analysis. Multivariate analysis was performed to control for study variables. Our study was designed to detect a clinically important difference between groups, which we defined as a 13% difference.Results: A total of 125 patients were enrolled, 63 randomized to the point-of-care ultrasonography group and 62 to physical examination alone. After loss to follow-up and misallocation, 54 patients in the ultrasonography group and 53 in the physical examination alone group were analyzed. The overall failure rate for all patients enrolled in the study was 10.3%. Patients who were evaluated with ultrasonography were less likely to fail therapy and have repeated incision and drainage, with a difference between groups of 13.3% (95% confidence interval 0.0% to 19.4%). Abscess locations were predominantly torso (21%), buttocks (21%), lower extremity (18%), and axilla or groin (16%). There was no difference in baseline characteristics between groups relative to abscess size, duration of symptoms before presentation, percentage with cellulitis, and treatment with antibiotics.Conclusion: Patients with soft tissue abscesses who were undergoing incision and drainage with point-of-care ultrasonography demonstrated less clinical failure compared with those treated without point-of-care ultrasonography.

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Section: Discussionmentioning

confidence: 99%

Abscess Incision and Drainage With or Without Ultrasonography: A Randomized Controlled Trial

Gaspari

Sanseverino

Gleeson

2019

Annals of Emergency Medicine

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“…Depending on the size of the abscess, incision and drainage may also be sufficient for infections with community‐acquired (CA) MRSA . […] Given the high prevalence of PVL‐positive MRSA (USA300), the results from recent studies on abscesses and ABSSSI conducted in the US cannot be directly compared to the situation in Central Europe […].…”

Section: Introductionmentioning

confidence: 99%

S2k guidelines for skin and soft tissue infections Excerpts from the S2k guidelines for “calculated initial parenteral treatment of bacterial infections in adults – update 2018“

Sunderkötter

Becker

Eckmann³

et al. 2019

J Deutsche Derma Gesell

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ZusammenfassungDiese erste deutschsprachige S2k-Leitlinie zu bakteriellen Haut-und Weichgewebeinfektionen ist im Rahmen der "Empfehlungen zur kalkulierten parenteralen Initialtherapie bakterieller Erkrankungen" unter Federführung der Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. entstanden und wird in wichtigen Auszügen hier wiedergegeben.Voraussetzung für gut kalkulierte Antibiotikatherapien ist eine genaue diagnostische Zuordnung. So wird das Erysipel definiert als nichteitrige Infektion als deren Erreger β -hämolysierende Streptokokken gelten, und das klinisch diagnostiziert wird

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“…Investigation of trimethoprim/sulfamethoxazole resistance in an emerging sequence type 5 methicillin-resistant Staphylococcus aureus clone reveals discrepant resistance reporting In regions where community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is common, oral trimethoprim/sulfamethoxazole (SXT) is a treatment option for skin and soft tissue infections. Recent trials have demonstrated noninferiority of SXT compared to intramuscular benzathine benzylpenicillin [1] or oral clindamycin [2] for treatment of uncomplicated skin and soft tissue infections such as impetigo [1], cellulitis and simple abscesses [2]. Concern over the increasing rates of community-acquired S. aureus isolates reported as SXT resistant has resulted in recommendations against prescribing SXT for the treatment of skin and soft tissue infections in the Kimberley region of Western Australia [3].…”

mentioning

confidence: 99%

Investigation of trimethoprim/sulfamethoxazole resistance in an emerging sequence type 5 methicillin-resistant Staphylococcus aureus clone reveals discrepant resistance reporting

Harris

Bowen

Holt

et al. 2018

Clinical Microbiology and Infection

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A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses

Cited by 169 publications

References 17 publications

Abscess Incision and Drainage With or Without Ultrasonography: A Randomized Controlled Trial

Abscess Incision and Drainage With or Without Ultrasonography: A Randomized Controlled Trial

S2k guidelines for skin and soft tissue infections Excerpts from the S2k guidelines for “calculated initial parenteral treatment of bacterial infections in adults – update 2018“

Investigation of trimethoprim/sulfamethoxazole resistance in an emerging sequence type 5 methicillin-resistant Staphylococcus aureus clone reveals discrepant resistance reporting

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