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.