title: Does adjuvant antibiotic treatment after drainage of anorectal abscess prevent development of anal fistulas? A randomized, placebo-controlled, double-blind, multicenter study.
abstract: BACKGROUND
  The risk of fistula formation is a major concern after incision and drainage of an anorectal abscess.
  
  
  OBJECTIVE
  Our objective was to the test the effects of antibiotic treatment on fistula formation after incision and drainage of anorectal abscesses.
  
  
  METHODS
  Randomized, placebo-controlled, double-blind study.
  
  
  METHODS
  Multicenter trial at 3 teaching hospitals in Turkey.
  
  
  METHODS
  Patients who underwent abscess drainage between September 2005 and January 2008 were evaluated for eligibility. Exclusion criteria included penicillin allergy, antimicrobial agent usage before enrolment, other infection, previous anorectal surgery, inflammatory bowel disease, suspicion of Fournier gangrene, secondary and recurrent anorectal abscesses, anal fistula at time of the surgery, immune compromised states, and pregnancy.
  
  
  METHODS
  Patients were randomly assigned to receive placebo or amoxicillin-clavulanic acid combination treatment for 10 days after abscess drainage.
  
  
  METHODS
  The primary end point was rate of anorectal fistula formation at 1-year follow-up.
  
  
  RESULTS
  : Of 334 patients assessed for eligibility, 183 entered the study (placebo, 92; antibiotics, 91). Data were available for per-protocol analysis from 151 patients (placebo, 76; antibiotics, 75) with a mean age of 37.6 years; 118 patients (78.1%) were men. Overall, 45 patients (29.8%) developed anal fistulas during 1-year follow-up. Fistula formation occurred in 17 patients (22.4%) in the placebo group and in 28 patients (37.3%) in the antibiotic group (P = .044). Risk of fistula formation was increased in patients with ischiorectal abscess (odds ratio, 7.82) or intersphincteric abscess (odds ratio, 3.35) compared with perianal abscess.
  
  
  CONCLUSIONS
  Antibiotic treatment following the drainage of an anorectal abscess has no protective effect regarding risk of fistula formation.
authors: Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey. ayhankuzu@yahoo.com
authors: Ulas
authors: U
authors: Sözener
authors: Ercan
authors: E
authors: Gedik
authors: Ahmet
authors: A
authors: Kessaf Aslar
authors: Hakan
authors: H
authors: Ergun
authors: Atilla
authors: A
authors: Halil Elhan
authors: Osman
authors: O
authors: Memikoğlu
authors: Ayhan
authors: A
authors: Bulent Erkek
authors: Mehmet
authors: M
authors: Ayhan Kuzu
mesh_terms: D000038:Abscess / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use*; D001003:Anal Canal / Q000473:pathology / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001004:Anus Diseases / Q000517:prevention & control*; D017024:Chemotherapy, Adjuvant; D004311:Double-Blind Method; D004322:Drainage; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination