Thursday, December 19, 2013

Unnecessary Antibiotics for Skin and Soft Tissue Infections

Here is an article published in The American Journal of Medicine on the unnecessary use of antibiotics for uncomplicated skin and soft tissue infections.

A total of 364 cases were included in a single center, retrospective analysis (155 cellulitis, 41 wound infection, and 168 abscess). Antibiotics active against methicillin-resistant Staphylococcus aureus were prescribed in 61% of cases of cellulitis. Of 139 cases of abscess where drainage was performed, antibiotics were prescribed in 80% for a median of 10 (interquartile range, 7-10) days. Of 292 total cases where complete prescribing data were available, avoidable antibiotic exposure occurred in 46%. This included use of antibiotics with broad gram-negative activity in 4%, combination therapy in 12%, and treatment for 10 or more days in 42%. Use of the short-course, single-antibiotic treatment strategies would have reduced prescribed antibiotic-days by 19% to 55%.
As summarized in the IDSA skin and soft tissue infections guidelines, for uncomplicated infections, especially for boils, drainage is paramount. Short courses (5-7 days) of a single antibiotic may be of minimal value following drainage.

Like with upper respiratory infections, which are typically viral, antibiotics are over prescribed for uncomplicated skin and soft issue infections.

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