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Friday, May 07, 2010

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!


Unknown said...

Very well proven that ischiorectal abscesses , EVEN WITH systemic signs of infection, most often need only thorough incision and drainage. No antibiotics usually needed. Exceptions include immunosuppressed states.

Okuns said...

We have the same issues here in Nigeria. Some patients expect antibiotics when they have body aches. Fortunately for me, I am not in private practice, so if you don't need antibiotics I don't give. I don't give antibiotics for uncomplicated colds and I restrict antibiotics to 24 hours max after major pelvic surgeries and caesarean sections. The most important factors influencing infection rates are the duration of surgery, type of surgery (dirty vs clean) and the skill of the surgeon.

Unknown said...

In India, if you don't prescribe antibiotics after any surgical procedure, you get 'the look'

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