May 22, 2013

DynaMed EBM Journal Volume 8, Issue 21

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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: May 22, 2013

Expiration Date: May 22, 2014

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD - Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

James McLellan, PhD - Senior Medical Writer, DynaMed, Ipswich, Massachusetts, USA


Dr. Ehrlich, Dr. Fleming, Dr. McLellan, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 8, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 6, 2013. Term of approval is for one year from this date with the option of yearly renewal. Each weekly updated is approved for 0.25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

Program ID: 1304158C


Last week 470 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 207 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

Antibiotics After Incision and Drainage of Uncomplicated Skin Abscesses Do Not Appear to Increase Clinical Cure Rates
Reference: Emerg Med J 2013 May 18 early online, (level 2 [mid-level] evidence)

Skin abscesses are a common complaint in adults and children presenting to emergency departments. The standard treatment is incision and drainage, and there has been evidence since the mid-1980s that adjunctive antibiotics do not appear to be necessary in uncomplicated cases (Ann Emerg Med 1985 Jan;14(1):15). Nonetheless, adjunctive systemic antibiotics are often prescribed. Some of the rationale for this may be related to the emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a significant pathogen, with reports of MRSA present in more than half of abscesses (N Engl J Med 2006 Aug 17;355(7):666). Practice guidelines from the Infectious Diseases Society of America indicate that antibiotics are usually unnecessary, but that additional data are needed to determine the proper role of antibiotics in this setting (Clin Infect Dis 2011 Jun 15;52(12):1468). A new systematic review analyzed data from 4 randomized trials evaluating antibiotic treatment following drainage of uncomplicated skin abscesses in 589 adults and children.

There were 2 trials that used antibiotics potentially active against MRSA (both used trimethoprim-sulfamethoxazole) and 2 trials that used antibiotics active against methicillin-sensitive Staphylococcus aureus, but not MRSA (cephalexin [Keflex] in 1 trial, and cephridine in the other). Patients with complicated abscesses were excluded in all trials. Rates of MRSA infection ranged from 53% to 88%. The primary endpoint was clinical cure at 7 days in 3 of the trials and at 10 days in 1 trial. The 2 trials of trimethoprim-sulfamethoxazole also reported longer term recurrence rates.

There were no significant differences in clinical cure rates (odds ratio 1.17, 95% CI 0.7-1.95) in an analysis of all trials. Trimethoprim-sulfamethoxazole was associated with a nonsignificant reduction in recurrence at 30 or 90 days (risk difference 10%, p = 0.1) in an analysis of 2 trials that included only 52% of the randomized patients. Based on these results, there does not seem to be a role for antibiotics in the management of uncomplicated abscesses. It should be noted that antibiotics still have a role for patients with complicated abscesses (such as those accompanied by systemic symptoms), immunocompromised patients, and for abscesses with significant surrounding cellulitis or in areas difficult to drain, such as the hand.

For more information, see the Skin abscess and Treatment of MRSA skin and soft tissue infections topic in DynaMed.

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For more information on this educational activity, see the CME sidebar.

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