Closing the Evidence-Practice Gap: A Quality Improvement Audit of Antibiotic Prescribing Following Incision and Drainage of Superficial Skin, Pilonidal and Perianal Abscesses

BackgroundSuperficial abscesses are a common presentation to emergency and surgical services, typically managed with incision and drainage (I&D).For superficial skin abscesses, evidence suggests that adjunctive antibiotic therapy reduces treatment failure and recurrence, whereas the benefit in perianal abscesses remains less certain; in either case, prescribing practices remain inconsistent.At an Australian metropolitan teaching hospital, a baseline audit revealed poor adherence to local antibiotic prescribing guidelines following I&D of superficial skin and perianal abscesses, with variability in both antibiotic choice and duration. MethodA retrospective audit of antibiotic prescribing in 49 patients undergoing I&D of superficial skin, pilonidal or perianal abscesses over a six-week period was performed.Patients with systemic infection or sepsis precluding immediate discharge, recurrent abscesses, deep-space extension, or those requiring drain insertion were excluded.Educational interventions were then implemented, including dissemination of a concise prescribing guideline via posters, email communication, and an in-person departmental meeting.A re-audit over the following six weeks was subsequently conducted; 59 patients met the inclusion criteria. ResultsA total of 108 patients were included across both audit cycles (49 pre-intervention, 59 post-intervention).Pre-intervention, 7/49 patients (14.3%) received guideline-concordant antibiotic therapy, indicating significant under-prescribing relative to local guidelines at baseline.Following the educational intervention, this increased to 24/59 patients (40.7%), representing an absolute improvement of 26.4 percentage points (95% CI: 10.5 to 42.3; χ²=9.11,p=0.0025).Although the confidence interval is wide, reflecting the modest sample size, it excludes no effect and is consistent with a clinically meaningful improvement in prescribing behaviour.It is notable, however, that 35/59 patients (59.3%) still did not receive guideline-concordant therapy following the intervention, underscoring that substantial room for improvement remains. ConclusionA simple educational intervention was associated with a clinically meaningful improvement in guidelineconcordant antibiotic prescribing following abscess drainage, though the 70% compliance target was not reached, highlighting the limits of single-cycle educational initiatives in achieving full guideline concordance.For superficial skin abscesses, the evidence base is robust and efforts to embed guideline awareness into clinical practice are justified.For perianal abscesses, the evidence remains conflicting, and further high-quality trial data are needed before definitive prescribing recommendations can be made.