Antibiotics Not Necessary to Treat Most Abscesses, Even in the Presence of MRSA

WASHINGTON, D.C. -- A 30-year review of the medical literature concerning a common skin infection reveals that abscesses treated by simple incision and drainage heal just as well as those treated with incision, drainage and antibiotics. An article appearing online in the Annals of Emergency Medicine finds that, except in cases where cellulitis is present, abscesses can be treated successfully without antibiotics, even in an environment heavily contaminated with methicillin-resistant Staphylococcus aureus (MRSA).

The typical treatment for an emergency patient with a skin abscess is incision, drainage and antibiotics, but it looks like incision and drainage alone are enough, said study author Worth W. Everett, MD, of the University of Pennsylvania Department of Emergency Medicine.  Given widespread concerns about antibiotic misuse and antibiotic resistance, this could change how we treat this very common emergency department complaint for both adults and children.

MRSA, a powerful Staph infection sometimes referred to as a superbug, has proliferated recently in many public settings, including hospitals and health care facilities. Its most famous outbreak occurred in the locker room of the Redskins football team, first in 2004. MRSAs resistance to many antibiotics and potential to cause harm to people with both normal and compromised immune systems have raised alarm among many health care workers.

Patients tend to clamor for antibiotics, even in situations where the evidence is clear that they are ineffective, such as with the common cold or the flu, said Dr. Everett.  The body has a tremendous ability to heal itself over time, and we can now see that this includes skin abscesses, at least those that do not include cellulitis.  The current research simply does not support the routine practice of prescribing antibiotics following incision and drainage of simple abscesses. 

The National Institutes of Health (NIH) has solicited proposals to study on a broader scale how to treat skin and soft tissue infections, including abscesses, and whether antibiotics are necessary.

Every study we looked at came to the same conclusion: abscesses treated with incision and drainage alone healed at the same rate as abscesses treated with incision, drainage and antibiotics, said Everett. If the anticipated NIH study supports the findings of the last 30 years, this may help stem the tide of antibiotic overuse. The next step, of course, will be to reinforce to the public the message that they dont need antibiotics to treat every ailment.

Source: American College of Emergency Physicians