Antibiotics after incision and drainage for uncomplicated skin abscesses: A clinical practice guideline

What role do antibiotics have in the treatment of uncomplicated skin abscesses after incision and drainage? A recent study suggested that, for small uncomplicated skin abscesses, antibiotics after incision and drainageimprove the chance of short term cure compared with placebo. Triggered by this trial, the Rapid Recommendation team produced a new systematic review. Relying on this review and using the GRADE framework according to the BMJ Rapid Recommendation process, an expert panel makes a weak recommendation in favour of trimethoprimsulfamethoxazole (TMP-SMX, co-trimoxazole) or clindamycin in addition to incision and drainage over incision and drainage alone. For patients who have chosen to initiate antibiotics, the panel issues a strong recommendation for TMP-SMX or clindamycin rather than a cephalosporin and a weak recommendation for TMP-SMX rather than clindamycin. The box overleaf shows the articles and evidence linked to this Rapid Recommendation. The infographic presents the recommendations together with other pertinent information, including an overview of the absolute benefits and harms of candidate antibiotics in the standard GRADE format. The panel emphasises shared decision making in the choice of whether to initiate antibiotics and in which antibiotic to use, because the desirable and undesirable consequences are closely balanced: clinicians using MAGICapp (http://magicapp.org/goto/guideline/jlRvQn/section/ ER5RAn) will find decision aids to support the discussion with patients. Table 2 below shows any evidence that has emerged since the publication of this article.