title: The role of adjunctive antibiotics in the treatment of skin and soft tissue abscesses: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To perform a review and meta-analysis on the effect of antibiotics on treatment of skin and soft tissue abscesses (SSTAs) after incision and drainage.
  
  
  METHODS
  We searched MEDLINE, EMBASE, Web of Knowledge, and Google Scholar databases to identify randomized controlled trials (RCTs) and observational studies. For RCTs, we included studies comparing any antibiotic (treatment) to placebo (control). For observational studies, treatment was the use of appropriate antibiotics effective against bacterial isolate, and control was the use of inappropriate (ineffective) or no antibiotics. Outcome was treatment success during follow-up. Two investigators reviewed records, assessed quality (according to Cochrane and Newcastle-Ottawa tools), and extracted treatment success rates. Primary analysis was the effect of treatment among RCTs. Secondary analyses included the effect of treatment in 1) observational studies of confirmed methicillin-resistant Staphylococcus aureus (MRSA) infection (MRSA-only) and 2) all studies after 1998 (MRSA-era). We used random effects modelling, except when no heterogeneity was present when we used fixed effects.
  
  
  RESULTS
  We screened 1,968 records. Twelve were included (five RCTs, seven observational studies), representing 1,969 subjects. Seven enrolled from emergency departments, two from surgical clinics, and three from ambulatory clinics. Three enrolled children only. Pooled relative risk (RR) of treatment success among RCTs was 1.03 (95% confidence interval [CI] 0.97-1.08). Pooled RR in the secondary analyses was 1.05 (95% CI 0.96-1.15) in MRSA-only and 0.99 (95% CI 0.98-1.01) in MRSA-era.
  
  
  CONCLUSIONS
  Despite limitations in pooling available data, there is no clear evidence to support antibiotic use in treating uncomplicated SSTAs.
authors.affiliation: *Department of Emergency Medicine,Alameda Health System,Highland Hospital,Oakland,CA.
authors.forename: Jahan
authors.initials: J
authors.lastname: Fahimi
authors.affiliation: *Department of Emergency Medicine,Alameda Health System,Highland Hospital,Oakland,CA.
authors.forename: Amandeep
authors.initials: A
authors.lastname: Singh
authors.affiliation: *Department of Emergency Medicine,Alameda Health System,Highland Hospital,Oakland,CA.
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Frazee
mesh_terms: D000038:Abscess / Q000188:drug therapy* / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D006801:Humans; D011182:Postoperative Care / Q000379:methods*; D017192:Skin Diseases, Bacterial / Q000188:drug therapy* / Q000601:surgery; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents
keywords: abscess; antibacterial agents; methicillin-resistant Staphylococcus aureus