Almost a year old now, but it’s been dredged up for Journal Club (spoiler alert: the next two days might have something in common with vis-a-vis dredging).
Small study randomizing skin abscess to placebo vs. TMP-SMX after incision and drainage in children. I think it’s a fair article with decent external validity, as I would say this directly addresses the practice pattern of pediatric emergency physicians, let alone community pediatricians. The real issue is statistical power for their secondary endpoint and some minor differences between their two groups. Treatment failures comparing placebo and TMP-SMX are identical – which just goes to show you that the I&D really is the most important element of treating abscesses. They do a lot of packing! I suppose I’m almost more surprised there isn’t more packing, since that’s the commonly accepted practice, but I digress.
The only fire remaining in their argument is that antibiotics will decrease recurrent abscesses. And, I am willing to give them that – although, I really expect, if they had a longer follow-up period, a lot of those abscesses would return after the antibiotics were stopped because the environment requires eradication. However, there’s a significant difference in the number of each group with a history of recurrent abscesses favoring the TMP-SMX group, which might explain the magnitude of their difference in recurrent lesions within 10 days.
Too small a study to change our practice – although, our practice probably should never have changed from not treating abscesses with antibiotics in the first place.