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Commentary on: Daum RS, Miller LG, Immergluck LA, et al. Placebo-controlled trial of antibiotics for smaller skin abscesses. N Engl J Med 2017;376:2545–55.
The primary treatment of a skin abscess is drainage. Past studies of adjunctive antibiotic treatment conducted before and after the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) in the USA and other parts of the world were small and did not clearly demonstrate benefit. In 2016, Talan et al 1 reported a US randomised placebo-controlled trial (RCT) among 1265 mostly adults, including some with co-morbidities, which demonstrated that treatment with an antibiotic possessing in vitro activity against MRSA, trimethoprim–sulfamethoxazole (TMP-SMX), was associated with a significantly higher short-term cure rate among patients with a drained skin abscess ≥2 cm in diameter. TMP-SMX-treated participants also had fewer additional drainage procedures and new site skin infections through 4–6 post-treatment. Overall adverse event rates were similar, with slightly …
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