How would you approach this patient? Incision and drainage are clearly indicated, but what about antibiotics? Should the wound be packed? Should the child be decolonized? How?

Classically, antibiotics have not been prescribed once an abscess has been drained; however, with the emergence of community associated MRSA (CA-MRSA) many have advocated antibiotics. There is also the concern for a cellulitic component to these processes in children. Two recent studies have addressed this question in pediatric populations. In a randomized, double-blind, controlled trial, Chen et al. compared clindamycin to cephalexin, assuming that clindamycin would be superior because of its efficacy against CA-MRSA.1 The primary outcome was clinical improvement at 48 to 72 hours, and the secondary outcome was resolution at 7 days. Participants were 6 months to 18 years old who presented to the ER with an abscess, furuncle, or carbuncle in which outpatient management was expected, and received a...

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