1、单纯表皮脓肿切开引流术后抗生素使用指南,Antibiotics after incision and drainage for uncomplicated skin abscesses: a clinical practice guideline,发表时间：2018 年 2 月 6 日全名：英国医学杂志（British medical journal）,四大顶级医学期刊,1.新英格兰医学杂志（new England journal of medicine）2.柳叶刀（lancet）3.美国医学会杂志（journal of American medical association）4.英国医学杂
2、志（British medical journal）,IF（影响因子）72.40645.21735.28919.6967,表皮脓肿切开引流术后是否需要使用抗生素？,抗生素的选择,复方新诺明 V.S. 克林霉素,指南适用范围,该指南适用人群为几乎所有皮肤脓肿患者，包括：（1）既适用于成人，又适用于儿童；（2）病原菌尚未能明确，甚至不能查明者也适用；（3）无论是小的脓肿还是大的脓肿均适用；（4）可应用于急诊及社区基层医疗场合。,以下情况该指南并不适用：（1）有证据显示存在系统性疾病（脓毒血症）；（2）深层组织感染；（3）免疫功能低下状态；（4）未行切除或引流治疗的皮肤脓肿患者。,数据来源,1.Da
3、um RS, Miller LG, Immergluck L, et al. DMID 07-0051 Team. A placebo controlled trial of antibiotics for smaller skin abscesses. N Engl J Med 2017;376:2545-55. 2. Talan DA, Mower WR, Krishnadasan A, et al. Trimethoprim sulfamethoxazole versus placebo for uncomplicated skin abscess. N Engl J Med 2016;
4、374:823-32. 3. Duong M, Markwell S, Peter J, Barenkamp S. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient. Ann Emerg Med 2010;55:401-7 4. Llera JL, Levy RC. Treatment of cutaneous abscess: a double-blind clinical study. Ann
5、Emerg Med 1985;14:15-9. 5. Schmitz GR, Bruner D, Pitotti R, et al. Randomized controlled trial of trimethoprim-sulfamethoxazole for uncomplicated skin abscesses in patients at risk for community-associated methicillin-resistant6.Staphylococcus aureus infection. Ann Emerg Med 2010;56:283-7. Macfie J,
6、 Harvey J. The treatment of acute superficial abscesses: aprospective clinical trial. Br J Surg 1977;64:264-6 7. Giordano PA, Elston D, Akinlade BK, et al. Cefdinir vs. cephalexin for mild to moderate uncomplicated skin and skin structure infections in adolescents and adults. Curr Med Res Opin 2006;
7、22:2419-28. 8. Miller LG, Daum RS, Creech CB, et al. DMID 07-0051 Team. Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections. N Engl J Med 2015;372:1093-103 9. Keiichi F, Eiichiro N, Hisashi T. Clinical evaluation of cefadroxil in the treatment of superficial suppurativ
8、ve skin and soft tissue infections a double-blind study comparing to L-cephalexin. Clin Eval 1982;10:175-200. 10. Rajendran PM, Young D, Maurer T, et al. Randomized, double-blind,placebo-controlled trial of cephalexin for treatment of uncomplicated skinabscesses in a population at risk for community
9、-acquired methicillinresistant Staphylococcus aureus infection. Antimicrob Agents Chemother 2007;51:4044-8.,(Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT00730028.),(Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00729
10、937.),(Funded by the National Institute of Allergy and Infectious Diseases and the National Center for Advancing Translational Sciences, National Institutes of Health; ClinicalTrials.gov number, NCT00730028.),结论,首先第一条推荐在皮肤脓肿切除 / 引流术后加用抗菌药物是一条弱推荐。第二条，当确定要加用抗菌药物时，不推荐选用一二代头孢菌素是一条强推荐。第三条讲在复方新诺明与克林霉素之间，首先前者是弱推荐。据原文描述之所以优选复方新诺明是因为其腹泻的发生率明显低于克林霉素，这一条不建议严格执行，建议具体情况具体分析，个体化给药。,
