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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
You are seeing a patient with a simple small abscess and no or minimal overlying cellulitis, nontoxic and afebrile, immunizations up to date, no prior abscesses. After successful incision and drainage, what treatment would you give?
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July 31, 2018 at 9:46 am
Several recent high quality randomized controlled trials have concluded that there is a higher cure rate for small abscesses with antibiotics compared to with I&D alone: Talan et al (NEJM 2016;374:823) found a cure rate of 80.5% with TMP-SMX compared to 73.6% with Placebo in 1247 patients > 12yo with uncomplicated abscess (NNT = 14.5); Daum et al (NEJM 2017;376:2545) found cure rates of 83.1% with clindamycin, 81.7% with TMP-SMX, and 68.9% with Placebo in 786 adults and children with small abscesses (NNT = 7), there was no difference between the efficacy of Clindamycin and TMP-SMX for SSTI (Miller et al NEJM 2015;372:1093). Holmes et al (J Pediatr 2016;169:128) found a higher rate of treatment failure with 3 days compared to 10 days of TMP-SMX after I&D of skin abscesses (NNT = 25 if organism unknown, NNT = 10 if MRSA).