abcess antibiotics

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iBS1972

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Hello, just wondering if anyone has treated an abscess with just antibiotics. It seems like that the general practice is to do I/D +/- antibiotics. Also, what are some common antibiotics that have good abscess penetration? I'm guessing that the antibiotic you're using would be even more tailored to the type of abscess you're treating (ex. GI vs. superficial), right? Thanks everyone in advance.

Edit: I/D or percutaneous drainage under guidance.

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Hello, just wondering if anyone has treated an abscess with just antibiotics. It seems like that the general practice is to do I/D +/- antibiotics. Also, what are some common antibiotics that have good abscess penetration? I'm guessing that the antibiotic you're using would be even more tailored to the type of abscess you're treating (ex. GI vs. superficial), right? Thanks everyone in advance.

Edit: I/D or percutaneous drainage under guidance.

I believe the antibiotic is usually chosen to cover the presumed pathogen. I do know that clinda, flagyl, and fluoroquinolones can often penetrate most tissues well and I think some abcesses as well. The problem is with the inoculum effect. Many bacteria clustered in an abcess will not be in the log growth phase, so antibiotics will be less effective. This as well as the limited antibiotics penetration means you always need to drain and then deescalate antibiotics adds on cultures.
 
It's a question of source control. Most abscesses just need a good I&D, not antibiotics. There is marginal utility in giving abx to someone with an abscess, but it's often outweighed by the harms of the medicine. If you don't have source control or the patient is bacteremic, that's a different beast.

That being said, many physicians will prescribe antibiotics for abcesses. And where it is matters a ton - lung abscess is very different from skin and soft tissue.
 
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It's a question of source control. Most abscesses just need a good I&D, not antibiotics. There is marginal utility in giving abx to someone with an abscess, but it's often outweighed by the harms of the medicine. If you don't have source control or the patient is bacteremic, that's a different beast.

That being said, many physicians will prescribe antibiotics for abcesses. And where it is matters a ton - lung abscess is very different from skin and soft tissue.
Agreed. I use antibiotics for skin abscesses quite frequently (data be damned) with good success.
 
It's a question of source control. Most abscesses just need a good I&D, not antibiotics. There is marginal utility in giving abx to someone with an abscess, but it's often outweighed by the harms of the medicine. If you don't have source control or the patient is bacteremic, that's a different beast.

That being said, many physicians will prescribe antibiotics for abcesses. And where it is matters a ton - lung abscess is very different from skin and soft tissue.

Thanks for your response. I am aware that I&D is the main method of treatment for most abscesses. I know that for lung abscesses and amoebic liver abscesses are not indications for drainage, but rather antibiotics being the main treatment. Are there other exceptions that you can think of?

Edit: lung abscesses that do not cause complicated parapneunomic effusion or empyema.
 
Im a little rusty on my IM but I thought the teaching was for a skin abscess that I&D/source control without antibiotics was often sufficient.
 
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