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 20 February 2018

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News

Antibiotics vs percutaneous drainage for intra-abdominal abscesses

Most patients with intra-abdominal abscesses improve with antibiotics, however, those with an abscess diameter of 7 cm, and a high temperature at admission require percutaneous drainage, finds February's Diseases of the Colon & Rectum.

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There is no definite consensus on the management of intra-abdominal abscesses in adults.

Dr Ravin Kumar and colleagues from the USA compared the use of antibiotic therapy and percutaneous image-guided drainage for intra-abdominal abscesses.

The team conducted a retrospective study of 114 adult patients with intra-abdominal abscesses.

The team collected data on patient demographics, presenting symptoms, radiographic interpretation, and vital signs.

Antibiotic coverage, laboratory values, and details of the hospital course was also assessed.

Bivariate statistical tests were performed using the Wilcoxon rank-sum test, chi-squared test, or Fisher's exact test, where appropriate.

The researchers found that 59% of patients had intra-abdominal abscesses resulting from appendicitis.

About 26% had abscesses from diverticulitis, 11% resulted postoperatively, and 4% were of undetermined origin.

54% of patients improved with intravenous antibiotic therapy alone
Diseases of the Colon & Rectum

The researchers noted that 3% of patients failed conservative management, and underwent urgent operation.

The team observed that 54% of patients improved with intravenous antibiotic therapy alone.

The research team reported that 44% underwent image-guided percutaneous drainage after 48 to 72 hours of antibiotic therapy.

Patients who improved on antibiotics alone had average abscess diameter of 4 cm.

However, the team found that patients who underwent percutaneous drainage had average diameter of 7 cm.

The maximal temperature at time of admission was 100.8 °F for the antibiotic group and 101.2°F for percutaneous drainage group.

Dr Kumar's team concluded, “The majority of the patients with intra-abdominal abscesses improved with antibiotic therapy alone.”

“Those patients with an abscess diameter more than 7 cm and temperature at admission more than 101.2°F have higher likelihood of failing conservative therapy with antibiotics alone and requiring percutaneous drainage.”

Dis Col Rectum 2006: 49(2): 183-9
20 February 2006

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