Effectiveness of Outpatient Antibiotics After Surgical Drainage of Abscesses in Reducing Treatment Failure

Publication date: Available online 24 August 2018

Source: The Journal of Emergency Medicine

Author(s): Michael S. Pulia, Rebecca J. Schwei, Brian W. Patterson, Michael D. Repplinger, Maureen A. Smith, Manish N. Shah

Abstract

Background

The optimal approach to outpatient antibiotic use after surgical drainage of abscesses is unclear given conflicting clinical trial results.

Objective

Our primary objective was to evaluate the real-world effectiveness of outpatient antibiotic prescribing after surgical drainage of cutaneous abscesses on reducing treatment failure.

Methods

We performed a retrospective observational study using data extracted from the electronic health record of a single academic health care system. All emergency department (ED) visits that resulted in discharge with a surgical drainage of a cutaneous abscess procedure code were included in the sample. All visits were categorized into having received or not having received an antibiotic prescription at the index visit. Outcome frequencies were compared using Pearson's chi-squared test. A multivariable logistic regression model was used to estimate the odds of treatment failure among those who did and did not receive an antibiotic prescription at their index ED visit.

Results

The final sample consisted of 421 index ED visits, of which 303 (72%) received an antibiotic prescription. Treatment with antibiotics after drainage did not significantly reduce the odds of composite treatment failure within 30 days when controlling for sociodemographic and clinical encounter variables (odds ratio 0.52, 95% confidence interval 0.23–1.21).

Conclusions

This real-world, comparative effectiveness analysis did not demonstrate any significant reduction in treatment failure with the use of antibiotics after drainage of abscesses in the ED. It is unclear if the clinical benefit observed under controlled trial conditions will carry over to routine clinical practice where varied antibiotic regimens are the norm and local bacterial resistance patterns vary.

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