Abscess Drainage without Antibiotics?

I just read a paper this morning that gave conclusive evidence that antibiotics do not work after an Incision and Drainage procedure for an Abscess. That was rather surprising to me. How can a cavity that's filled with pus (essentially teeming with bacteria and what not) not respond to the very things that were invented to destroy said bacteria and what not!

The data suggested that there was no difference in the healing process in the placebo group and the group that received the antibiotics. They also report that the incidence of further infection was not affected by the antibiotics. So, 7 days after the incision, patients were no better no worse. I'm not so sure thats a good thing!

Taking this scenario and applying it in India would be akin to shutting your practice down. Why? Simple. Your patients will think you've lost it! "My doc is so stupid he didn't even prescribe me antibiotics". In a country that is widely known for abusing over the counter drugs, we have our chemist friends that happily dispense all antibiotics over the counter as well and almost no one I know asks for a prescription. Knowing this, do you think that even if I don't prescribe an antibiotic, I won't be asked for it? Wouldn't it just be bought anyway to 'be safe'?

Pharma companies - Lets not even get started there. They must already be conduction 'trials' to disprove this theory. Be realistic, if you won't prescribe antibiotics for an infection, what else is left??? (Of course, I'm generalising!)

                                                          

How about you? Would you feel comfortable not taking any antibiotics after getting a surgical procedure on your body to remove pus from an abscess cavity?? 

I want comments on this one!

Why we require to do a thorough Physical Examination every time.

A patient from out of town was in the clinic the other day with complaints of an unyielding fever and chills. She was a diabetic and usually was under good control. She was also obese and was considering bariatric surgery. On examination, she seemed to be fine other than the fever and a mild congestion. She was put on antipyretics and told to follow up again in a day or two.

She came back and the fever was higher. It had not gone down to normal at all. This time, we were sure that we had to find the focus of infection, it had to be somewhere. We did what we should have on the first day. Took a more detailed history and did a complete physical examination.

It was carefully tucked away, hidden by her overweight thighs, at the perineum. It was an acute perineal abscess. It was inflammed, almost pointing, gasping, waiting to be let out. She needed an incision and drainage and we knew it. Her blood sugar was high (as expected). We did the surgery, she felt better and was able to travel back to her home town in 2 days.

The question here is, should the patient have come clean about the boil she knew was festering in her perineal region (undoubtedly a very private place but....) or should we have insisted on a complete exam? The thing is, in India, where cultural influences are so strong, almost all women and most men will still not feel comfortable about their bodies being exposed even if it is for medical purposes!
In the west, I assume the Doctors are more cautious, what with the malpractice race closing in on them all the time. Here it's more the patient's unwillingness to admit something could be wrong in "that" region.

I would love to have a middle ground and say that its our duty to inform the patient that a complete medical examination is required, but how many would agree to strip down completely for 'just a fever'??

Any ideas??