Fully 90% of dermatologists said they would initially prescribe an antibiotic for a routine, uncomplicated cutaneous abscess, although guidelines recommend antibiotic use for complicated cases only.
The use of antibiotics for uncomplicated abscesses may contribute to the antibiotic resistance. The findings appear in the Journal of Drugs in Dermatology.
“These findings shine a light on discrepancies between clinical guidelines and clinical practice at a time when widespread misuse of antibiotics is contributing to the increased role of antibiotic resistance across the country,” says study author Adam Friedman, MD, director of dermatologic research at Montefiore Medical Center and assistant professor of medicine at the Albert Einstein College of Medicine of Yeshiva University in New York City.
National guidelines call for incision and drainage alone for the primary treatment of uncomplicated skin and soft tissue infections. Antibiotic treatment is recommended after incision and drainage only in certain populations, including those who present with symptoms such as fever, patients who are elderly or very young, patients with abscesses in difficult-to-drain areas, or patients who do not respond to incision and drainage alone.
Nearly all dermatologists surveyed (99%) were capable of performing incision and drainage and were likely to incorporate it their initial treatment alongside antibiotic use.
“These results add to a growing body of research suggesting that, across specialties, antibiotics are being used as a safety net in the management of routine skin infections even though incision and drainage alone is the gold standard,” Friedman says. “Comprehensive efforts to educate healthcare practitioners about local rates of antibiotic resistance could impact clinical practice.”
The study also showed gaps in dermatologist adherence to clinical guidelines including the frequent prescription of antibiotics that are ineffective against Methicillin-resistant Staphylococcus aureus and the decreased likelihood of performing incision and drainage procedures on infants.
The findings are based on a national email survey of 780 dermatologists conducted from May-June 2012. Response rate was 65%.