Letters to the Editor

Antimicrobial treatment of simple cutaneous abscesses

The veterinary literature has advocated the use of antimicrobials when treating simple cutaneous abscesses in dogs and cats. This has been based on the assumption that the use of antimicrobials will shorten infection time, prevent reestablishment of the abscess, accelerate healing, and prevent systemic complications. Although this may make sense logically, to my knowledge, there are no studies in the veterinary literature demonstrating the advantage of using antimicrobials to treat simple abscesses. On the other hand, there are studies1–6 that have questioned the use of antimicrobials in the treatment of cutaneous abscesses in people, even in patients infected with methicillin-resistant Staphylococcus aureus. With the exception of patients with cellulitis or a fever and patients that are immunocompromised, we may not only be giving medications that are not needed, we may also be subjecting our patients to the possibility of adverse reactions, as well as contributing to the problem of antimicrobial resistance.

The term abscess is used to describe a cavity containing purulent material. This material is walled off, thus isolating it and preventing spread to the surrounding tissues. Owing to the presence of the abscess wall, there is inherently little or no penetration by antimicrobials into the affected tissue, resulting in low concentrations within the abscess and poor efficacy. After an abscess matures and spontaneously ruptures or is surgically lanced, purulent material is evacuated. In addition, during surgical intervention, abscesses are routinely explored and lavaged. The end result in either case is a reduction in purulent material. Abscesses heal from the outer edges toward the drainage site. During this period, purulent material continues to be expelled. Notably, the abscess wall remains intact until the area is completely healed. Therefore, administration of antimicrobials during the healing process is just as ineffective as giving them prior to maturation of an abscess.

In an informal survey of 6 clinicians working in our referral and emergency hospital, representing a combined 75 years of experience, none were able to recall any complications, aside from reformation of an abscess secondary to early closure, related to simple cutaneous abscesses. Also, there are many cats that never receive antimicrobials, and yet we do not see increased complication rates in this at-risk population. Taken together, these findings tend to support the contention that antimicrobials are not needed after incision and drainage of a simple cutaneous abscess.

In the face of emerging concerns regarding antimicrobial resistance in veterinary practice as well as the strong evidence in the human literature questioning the use of antimicrobials in the treatment of simple cutaneous abscesses, it may be worthwhile reassessing our use of antimicrobials in our patients.

Michael Hall, DVM, DABVP

PetPB Animal Emergency and Referral Center Boynton Beach, Fla

  • 1.

    Duong M, Markwell S, Peter J, et al. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient [published online ahead of print]. Ann Emerg Med doi:10.1016/j.annermegmed.2009.03.014.

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  • 2.

    Korownyk C, Allan GM. Evidence-based approach to abscess management. Can Fam Physician 2007;53:16801684.

  • 3.

    Meislin HW, McGehee MD, Rosen P. Management and microbiology of cutaneous abscesses. JACEP 1978;7:186191.

  • 4.

    Rajendran PM, Young D, Maurer T, et al. Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection. Antimicrob Agents Chemother 2007;51:40444048.

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    • Search Google Scholar
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  • 5.

    Hankin A, Everett WW. Are antibiotics necessary after incision and drainage of a cutaneous abscess? Ann Emerg Med 2007;50:4951.

  • 6.

    Lee MC, Rios AM, Aten MF, et al. Management and outcome of children with skin and soft tissue abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J 2004;23:123127.

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Managing distressed animals

In recent years, veterinary medicine has made substantial strides in addressing and alleviating pain in animals. The time has now come, in my opinion, to address distress, even in the absence of pain.

Animals clearly feel distress. We see this every time we attempt to trim the nails of a fighting, squirmy dog or attempt to examine a cat that is growling and ready to explode before we ever touch it. I believe we all sigh deeply and wish for something to help us through these encounters. Perhaps if we start by acknowledging, maybe even addressing, the animal's distress, we can make progress.

How, then, do we proceed? I would suggest that the first step is to acknowledge that an animal might be distressed, even if we do not understand the reason why. The second step is to develop a strategy for dealing with that distress. Some of the strategies I have used in my own patients include the following:

  • • Feed high-value, nutritious treats throughout the procedure (eg, a puppy's first nail trim). Don't insist on good behavior because you are not rewarding the animal, simply trying to alleviate the distress associated with the procedure. Also, realize that this will not work with all animals; don't try forcing the animal to accept the treats.

  • • Sedate the animal prior to performing the procedure. Don't consider sedation only for painful procedures. Rather, in partnership with the owner, at least consider sedation for procedures that are distressing (eg, positioning in dorsal recumbency for radiography).

  • • Pay attention to timing. Sometimes, moving slowly will help alleviate distress, whether taking a temperature or administering a liquid medication.

  • • Consider not performing or altering the procedure. When performing a routine examination on a cat, how much information is obtained by measuring rectal temperature if the cat is distressed by the procedure? In a dog that objects to intranasal Bordetella vaccination, consider using an injectable vaccine instead.

  • • Press on as best you can. Sometimes, as we all know, we just have to do a procedure and do it now. In these cases, be as quiet, fast, and respectful as you can.

The essential skill involved when addressing distress is to determine how the animal is responding. Different animals will respond differently to different strategies. Therefore, don't try to develop a single strategy that you use consistently. Instead, assess how each individual animal is responding, and be prepared to try alternative strategies.

Chris Albert, DVM

Lebanon Junction, Ky

  • 1.

    Duong M, Markwell S, Peter J, et al. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient [published online ahead of print]. Ann Emerg Med doi:10.1016/j.annermegmed.2009.03.014.

    • Search Google Scholar
    • Export Citation
  • 2.

    Korownyk C, Allan GM. Evidence-based approach to abscess management. Can Fam Physician 2007;53:16801684.

  • 3.

    Meislin HW, McGehee MD, Rosen P. Management and microbiology of cutaneous abscesses. JACEP 1978;7:186191.

  • 4.

    Rajendran PM, Young D, Maurer T, et al. Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection. Antimicrob Agents Chemother 2007;51:40444048.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Hankin A, Everett WW. Are antibiotics necessary after incision and drainage of a cutaneous abscess? Ann Emerg Med 2007;50:4951.

  • 6.

    Lee MC, Rios AM, Aten MF, et al. Management and outcome of children with skin and soft tissue abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J 2004;23:123127.

    • Crossref
    • Search Google Scholar
    • Export Citation

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