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Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
  1. Wen Wang1,
  2. Wenwen Chen1,
  3. Yanmei Liu1,
  4. Reed Alexander C Siemieniuk2,3,
  5. Ling Li1,
  6. Juan Pablo Díaz Martínez4,
  7. Gordon H Guyatt2,
  8. Xin Sun1
  1. 1 Chinese Evidence-based Medicine Center and CREAT Group, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Centre, Sichuan, China
  2. 2 Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
  3. 3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Xin Sun; sunx79{at}hotmail.com

Abstract

Objective To assess the impact of adjunctive antibiotic therapy on uncomplicated skin abscesses.

Design Systematic review and network meta-analysis.

Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov.

Study selection A BMJ Rapid Recommendation panel provided input on design, important outcomes and the interpretation of the results. Eligible randomised controlled trials (RCTs) included a comparison of antibiotics against no antibiotics or a comparison of different antibiotics in patients with uncomplicated skin abscesses, and reported outcomes prespecified by the linked guideline panel.

Review methods Reviewers independently screened abstracts and full texts for eligibility, assessed risk of bias and extracted data. We performed random-effects meta-analyses that compared antibiotics with no antibiotics, along with a limited number of prespecified subgroup hypotheses. We also performed network meta-analysis with a Bayesian framework to compare effects of different antibiotics. Quality of evidence was assessed with The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results Fourteen RCTs including 4198 patients proved eligible. Compared with no antibiotics, antibiotics probably lower the risk of treatment failure (OR 0.58, 95% CI 0.37 to 0.90; low quality), recurrence within 1 month (OR 0.48, 95% CI 0.30 to 0.77; moderate quality), hospitalisation (OR 0.55, 95% CI 0.32 to 0.94; moderate quality) and late recurrence (OR 0.64, 95% CI 0.48 to 0.85; moderate quality). However, relative to no use, antibiotics probably increase the risk of gastrointestinal side effects (trimethoprim and sulfamethoxazole (TMP-SMX): OR 1.28, 95% CI 1.04 to 1.58; moderate quality; clindamycin: OR 2.29, 95% CI 1.35 to 3.88; high quality) and diarrhoea (clindamycin: OR 2.71, 95% CI 1.50 to 4.89; high quality). Cephalosporins did not reduce the risk of treatment failure compared with placebo (moderate quality).

Conclusions In patients with uncomplicated skin abscesses, moderate-to-high quality evidence suggests TMP-SMX or clindamycin confer a modest benefit for several important outcomes, but this is offset by a similar risk of adverse effects. Clindamycin has a substantially higher risk of diarrhoea than TMP-SMX. Cephalosporins are probably not effective.

  • antibiotics
  • uncomplicated skin abscesses
  • systematic review
  • network meta-analysis

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • WW, WC, YL and RACS contributed equally.

  • Contributors WW, WC, YL and RACS contributed equally to this work. RACS, GHG, XS and WW conceived the study. XS and WW had full access to all of the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis. WW and RACS designed the search strategy. WW, WC, YL and LL screened abstracts and full texts, and acquired the data and judged risk of bias in the studies. WW, RACS and JPDM performed the data analysis. WW, WC and YL wrote the first draft of the manuscript. RACS, LL, XS, JPDM, GHG critically revised the manuscript. All authors have approved the manuscript.

  • Funding XS was supported by the National Natural Science Foundation of China (grant no. 71573183) and ‘Thousand Youth Talents Plan’ of China (grant no. D1024002).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Extra data are available in the publication of the BMJ Rapid Recommendation in MAGICapp.

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