Avoid antibiotics and wound cultures in emergency department patients with uncomplicated skin and soft tissue abscesses after successful incision and drainage and with adequate medical follow-up.

Rationale and Comments

Skin and soft tissue infections are a frequent reason for visiting an emergency department. Some infections, called abscesses, become walled off and form pus under the skin. Opening and draining an abscess is the appropriate treatment; antibiotics offer no benefit. Even in abscesses caused by methicillin-resistant Staphylococcus aureus, appropriately selected antibiotics offer no benefit if the abscess has been adequately drained and the patient has a well-functioning immune system. Additionally, culture of the drainage is not needed as the result will not routinely change treatment.

Sponsoring Organizations

American College of Emergency Physicians

Sources

Randomized controlled trials

Disciplines

Emergency medicine
Infectious disease

References

Baumann BM, Russo CJ, Pavlik D, Cassidy-Smith T, Brown N, Sacchetti A, Capano-Wehrle LM, Mistry RD. Management of pediatric skin abscesses in pediatric, general academic and community emergency departments. West J Emerg Med. 2011May;12(2):159-67.
Duong M, Markwell S, Peter J, Barenkamp S. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient. Ann Emerg Med. 2010 May;55(5):401-7.
Llera JL, Levy RC. Treatment of cutaneous abscess: a double-blind clinical study. Ann Emerg Med. 1985;14:15-9.
Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary. National health statistics reports. Hyattsville, [MD]: National Center for Health Statistics. 2010. 31 p. Report no.: 26.