Systemic antibiotics after incision and drainage of simple abscesses: a meta-analysis

Abstract

Background: Over the last decade, there has been a significant increase in the number of cutaneous abscesses. While there is general agreement that abscesses should be treated with incision and drainage, it is unclear whether systemic antibiotics should be routinely prescribed.

Objective: To evaluate whether systemic antibiotics, when compared with a placebo, improve cure rates in patients with simple abscesses after incision and drainage.

Methods design: Systematic review and meta-analysis using RevMan5.

Patients and settings: Children and adults with simple abscesses treated in outpatient clinics or emergency departments.

Data sources: Cochrane Central, Medline, Embase and bibliographies.

Outcome measures: Percentage of patients with complete resolution of abscess without the need for recurrent incision and drainage, additional antibiotics, or hospital admission within 7-10 days of treatment.

Results: We included four trials, consisting of 589 patients in total (428 adults and 161 children). Patients were randomised to one of three antibiotics (cephridine (27), cephalexin (82), or trimethoprim sulfamethoxazole (161)) or to placebo (285), with 34 lost to follow-up or having incomplete data. When given in addition to incision and drainage, systemic antibiotics did not significantly improve the percentage of patients with complete resolution of their abscesses 7-10 days after treatment (88.1% vs 86.0%; OR 1.17 (95% CI 0.70 to 1.95)).

Conclusions: When given in addition to incision and drainage, systemic antibiotics do not significantly improve the percentage of patients with complete resolution of their abscesses.

Keywords: wounds, infection.