Practice Guidelines

Antibiotics for Uncomplicated Skin Abscesses After Incision and Drainage: BMJ Rapid Recommendation


Am Fam Physician. 2018 Sep 1;98(5):323-324.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• TMP-SMX or clindamycin can be combined with incision and drainage of skin abscesses to decrease the risk of treatment failure and recurrence.

• TMP-SMX is weakly recommended over clindamycin because of its lower risk of diarrhea.

• Cephalosporins are not likely to have reduced rates of treatment failure compared with incision and drainage alone.

From the AFP Editors

Skin abscesses, which are a collection of pus in the dermis and deeper tissues and often appear as erythematous and indurated nodules, typically result from a bacterial infection (e.g., methicillin-resistant Staphylococcus aureus). Current clinical guidelines recommend against the use of antibiotics for uncomplicated lesions after incision and drainage. Recently, however, a collaboration between the BMJ and the MAGIC group led an international panel made up of a variety of health care professionals (e.g., family physicians, internists, dermatologists) and adults with experience treating and living with skin abscesses to create recommendations regarding antibiotic use based on identified benefits, harms, cost, treatment burden, evidence quality, and patient preferences.

The recommendations apply to all adults and children with uncomplicated skin abscesses who present to the emergency department or family physician offices, including those with abscesses of all sizes, first occurrence or recurrence of abscesses, and abscesses with unknown pathogens. They do not apply to patients with systemic illnesses, deep tissue infection, superficial infection (e.g., pustules), hidradenitis suppurativa, or immunocompromising conditions, or to patients who do not require abscess incision and drainage.


Based on high-quality evidence, trimethoprim/sulfamethoxazole (TMP-SMX) or clindamycin combined with incision and drainage has been shown to decrease the risk of treatment failure by approximately 5% at one month and the risk of recurrence by approximately 8% at three months compared

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of Practice Guidelines published in AFP is available at



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