Results of a new survey to assess treatment of skin and soft tissue infections shows 90% of dermatologists said they would initially prescribe an antibiotic for a routine, uncomplicated cutaneous abscess; however, guidelines recommend antibiotic use only in complicated cases. Research shows the use of antibiotics for uncomplicated abscesses may contribute to the increased incidence of multi-drug resistant pathogens in the general population. These findings, from researchers at Montefiore Medical Center, were published in the Journal of Drugs in Dermatology.
Methicillin resistant Staphyloccus aureus (MRSA) is now the major source of skin infection in the U.S. These infections are generally uncomplicated at the time of initial presentation and can be managed in the outpatient setting. National guidelines for clinical care indicate incision and drainage (I+D) alone for the primary treatment of uncomplicated skin and soft tissue infections. Antibiotic treatment is recommended after I+D only in certain populations, including those who present with symptoms such as fever, patients who are elderly or very young, patients with abscesses in difficult to drain areas, or patients who do not respond to I+D alone. Nearly all dermatologists surveyed (99%) were capable of performing I+D and were likely to incorporate I+D into their initial treatment alongside antibiotic use.
“Dermatologists are reluctant to rely on incision and drainage alone, despite the fact that studies spanning more than 30 years fail to show antibiotics provide added benefit in the treatment of routine skin infections,” said Adam Friedman, M.D., director of dermatologic research, Montefiore, assistant professor of medicine, Albert Einstein College of Medicine of Yeshiva University, and lead author. “These findings shine a light on discrepancies between clinical guidelines and clinical practice at a time when widespread misuse of antibiotics is contributing to the increased role of antibiotic resistance across the country.”
This is the first published data on the extent to which dermatologists follow national guidelines in the treatment of abscesses. Other key takeaways reveal gaps in dermatologist adherence to clinical guidelines including the frequent prescription of antibiotics that are ineffective against MRSA and the decreased likelihood of performing I+D procedures on infants.
“These results add to a growing body of research suggesting that, across specialties, antibiotics are being used as a safety net in the management of routine skin infections even though incision and drainage alone is the gold standard,” said Dr. Friedman. “Comprehensive efforts to educate healthcare practitioners about local rates of antibiotic resistance could impact clinical practice.”
Management of Cutaneous Abscesses by Dermatologists, Authors: Jason Chouake MD, Aimee Krausz BA, Brandon L. Adler BA, Hillel W. Cohen PhD MPH, Joshua D. Nosanchuk MD, and Adam Friedman MD, J Drugs Dermatol. 2014;13(2):119-124
Montefiore Medical Center