Survey: Anti-MRSA drugs routinely prescribed for simple abscesses
FROM THE JOURNAL OF DRUGS IN DERMATOLOGY
Major finding: Ninety percent of dermatologists surveyed said they would prescribe an antibiotic that would cover MRSA when faced with an uncomplicated cutaneous abscess.
Data source: E-mail survey responses from 510 board-certified dermatologists
Disclosures: Dr. Friedman disclosed relationships with Onset, Valeant, and other companies.
Nearly 90% of more than 500 dermatologists surveyed said they would initially prescribe an antibiotic to cover possible methicillin-resistant Staphylococcus aureus when incising and draining an uncomplicated cutaneous abscess. Further, 24% reported prescribing antibiotics that are not active against the pathogen, and 82% said they cultured simple abscesses in 50% of cases.
The survey findings, while limited by their self-reporting nature, point to the need for clearer guidelines on the best approaches to simple abscesses.
"A comprehensive clinical guideline based on local antimicrobial rates, and increased knowledge of local resistance patterns and microbiologic data could not only improve abscess management and antibacterial stewardship, but could also combat the rising health care costs associated with SSTIs [skin and soft tissue infections] and their complications," wrote Dr. Adam Friedman and his colleagues in the February issue of the Journal of Drugs in Dermatology.
CDC/Gregory Moran, M.D.
Simple excision and drainage (I&D) is the standard treatment for an uncomplicated skin abscess. With the increase in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) as the culprit behind SSTIs in the United States, the Centers for Disease Control and Prevention recommends that health professionals consider CA-MRSA in all cases of skin abscesses, perform I&D, and use culture results to guide treatment, the researchers noted.
Guidelines from the Infectious Diseases Society of America recommend antibiotics for abscesses after I&D in certain circumstances, and coverage in the outpatient setting if needed. IDSA and other organizations currently recommend empiric coverage of CA-MRSA for acute bacterial skin and skin structure infections if and when antibiotics are incorporated into the therapeutic regimen (Clin. Infect. Dis. 2011;52: e18-e55).
The IDSA guidelines do not recommend culture for simple abscesses; however, 82% of the survey respondents said they cultured simple abscesses more than 50% of the time.
Overall, 459 respondents said that, for an uncomplicated abscess, they would initially prescribe an antibiotic that would cover methicillin-resistant Staphylococcus aureus (MRSA). Tetracycline class antibiotics were the top choice (35%), while 27% of respondents said they would use trimethoprim sulfamethoxazole. Interestingly, 24% said they would use a beta-lactam or cephalosporin, which do not cover MRSA, noted Dr. Friedman, of Montefiore–Albert Einstein College of Medicine, New York, and his colleagues.