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Página de Inicio arrow Artículos Científicos arrow Randomized, Controlled Trial of Antibiotics in the Management of Community-Acquired Skin Abscesses in the Pediatric Patient
Randomized, Controlled Trial of Antibiotics in the Management of Community-Acquired Skin Abscesses in the Pediatric Patient Imprimir E-Mail
Presented at the Pediatric Academic Society, May 2008, Honolulu, HI;
and the Midwest Society of Pediatric Research, October 2008,
Cleveland, OH.
Myto Duong, MD, MSa, Stephen Markwell, MAc, John Peter, MDa, Stephen
Barenkamp, MDb

Study objective

Emergency department visits for skin and soft tissue infections are
increasing with the discovery of community-acquired
methicillin-resistant Staphylococcus aureus. Whether abscesses treated
surgically also require antibiotics is controversial. There are no
published pediatric randomized controlled trials evaluating the need
for antibiotics in skin abscess management. We determine the benefits
of antibiotics in surgically managed pediatric skin abscesses.

Methods

This was a double-blind, randomized, controlled trial. Pediatric
patients were randomized to receive 10 days of placebo or
trimethoprim-sulfamethoxazole after incision and draining. Follow-up
consisted of a visit/call at 10 to 14 days and a call at 90 days.
Primary outcome was treatment failure at the 10-day follow-up.
Secondary outcome was new lesion development at the 10- and 90-day
follow-ups. Noninferiority of placebo relative to
trimethoprim-sulfamethoxazole for primary and secondary outcomes was
assessed.

Results

One hundred sixty-one patients were enrolled, with 12 lost to
follow-up. The failure rates were 5.26% (n=4/76) and 4.11% (n=3/73) in
the placebo and antibiotic groups, respectively, yielding a difference
of 1.15, with a 1-sided 95% confidence interval (CI) (1.15% to 6.8%).
Noninferiority was established with an equivalence threshold of 7%.
New lesions occurred at the 10-day follow-up: 19 on placebo (26.4%)
and 9 on antibiotics (12.9%), yielding a difference of 13.5, with 95%
1-sided CI (13.5% to 24.3%). At the 3-month follow-up, 15 of 52
(28.8%) in the placebo group and 13 of 46 (28.3%) in the antibiotic
group developed new lesions. The difference was 0.58, with 95% 1-sided
CI (0.5% to 15.6%).

Conclusion

Antibiotics are not required for pediatric skin abscess resolution.
Antibiotics may help prevent new lesions in the short term, but
further studies are required.
 
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