{ "slug": "pilonidal-cyst-antibiotics", "question": "Do antibiotics actually clear up a pilonidal cyst or abscess?", "shortTitle": "Antibiotics for Pilonidal Cyst/Abscess", "clinicalQuestion": "In patients with acute pilonidal disease (cyst, sinus, or abscess), does antibiotic therapy—alone or combined with incision and drainage—improve resolution of infection, reduce need for surgery, or lower recurrence compared with drainage/surgery alone or no antibiotics?", "pico": { "population": "Patients presenting with an acute pilonidal cyst, sinus, or abscess", "intervention": "Oral or intravenous antibiotic therapy, with or without incision and drainage", "comparator": "Incision and drainage or surgery alone, or no antibiotic treatment", "outcomes": [ "Resolution of infection without surgery", "Need for incision and drainage or excision", "Time to symptom resolution", "Recurrence rate at 3–12 months", "Abscess or wound complication rate", "Pain or symptom scores" ] }, "category": "anorectal", "relatedConditions": [ "pilonidal-disease", "pilonidal-abscess", "pilonidal-sinus" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "There isn't enough good evidence to say that antibiotics alone clear up a pilonidal cyst or abscess.", "detail": "Only one study tested this directly: a small group of people had their abscess drained with a needle and took a week of antibiotics, and most avoided a bigger surgical drainage — but there was no comparison group, so we can't tell how much the antibiotics themselves did. Two other trials found that adding antibiotics to the surgical wound was linked to worse healing or more infections, a signal of harm rather than reassurance that antibiotics are a safe add-on.", "studyIds": [ "pmid:29433863", "pmid:22595842", "pmid:16362397", "pmid:9574192" ] }, "strength": { "level": "very-low", "why": "The only direct evidence is 1 small or uncontrolled study.", "override": null }, "direction": { "level": "harm-signal", "why": "2 studies reported harm or tissue damage, including laboratory evidence.", "override": null }, "counts": { "recordsRetrieved": 90, "recordsScreened": 90, "included": 22, "rcts": 8, "systematicReviews": 0, "observational": 6, "participants": 1571, "yearFrom": 1985, "yearTo": 2025, "registeredTrialsWithoutResults": 2 }, "excluded": [], "outcomes": [ { "name": "Resolution of infection without surgery", "status": "possible-improvement", "note": "In two small studies with no comparison group, most people who had needle drainage plus about a week of oral antibiotics avoided a full surgical incision. Because nobody compared this with drainage alone, we don't know what the antibiotics added.", "studyIds": [ "pmid:29433863", "pmid:22595842" ] }, { "name": "Need for incision and drainage or excision", "status": "possible-improvement", "note": "Most people in these uncontrolled studies did not need a bigger surgical drainage after needle aspiration plus antibiotics, but some did, and case reports describe antibiotics failing entirely, with surgery needed afterward.", "studyIds": [ "pmid:29433863", "pmid:22595842", "pmid:30936332", "pmid:18369307" ] }, { "name": "Time to symptom resolution", "status": "insufficient", "note": "One study reported that responders were back to normal activity by the next day, but this wasn't measured carefully or compared with any other approach.", "studyIds": [ "pmid:22595842" ] }, { "name": "Recurrence rate at 3-12 months", "status": "insufficient", "note": "A large chart review found pilonidal disease recurred in about a third of patients overall, but it did not separate out people treated with antibiotics from those who weren't, so this doesn't answer the question.", "studyIds": [ "pmid:30463753" ] }, { "name": "Abscess or wound complication rate", "status": "possible-harm", "note": "One trial that placed a local antibiotic sponge in the wound during surgery found no significant difference in primary healing (66% with the sponge vs 69% without), but wound secretion lasted longer and hospital stay was longer in the antibiotic group. A separate trial comparing a single dose versus a 5-day course of antibiotics before surgery found significantly more wound infections with the shorter course. Both studied antibiotics used around planned surgery, not antibiotics used instead of surgery for an active abscess, but the worse outcomes seen with local antibiotic carriers and shorter courses are a caution.", "studyIds": [ "pmid:16362397", "pmid:9574192" ] }, { "name": "Pain or symptom scores", "status": "not-studied", "note": "No study in this review measured pain or symptom scores for antibiotics used to treat an active pilonidal cyst or abscess.", "studyIds": [] } ], "benefits": [ { "text": "In two small studies without a comparison group, draining the abscess with a needle and taking about a week of oral antibiotics let most people avoid a bigger surgical incision at that visit.", "studyIds": [ "pmid:29433863", "pmid:22595842" ] } ], "limitations": [ { "text": "The only study that directly tested antibiotics for an active abscess had no comparison group, so there's no way to know whether the antibiotics added anything beyond the needle drainage itself.", "studyIds": [ "pmid:29433863" ] }, { "text": "Most other trials tested antibiotics as a single dose or as a sponge placed in the wound during planned surgery — a very different situation from using antibiotics to treat an abscess that hasn't been drained.", "studyIds": [ "pmid:27383814", "pmid:20819439", "pmid:20734046", "pmid:16362397", "pmid:9574192", "pmid:7850048", "pmid:1395879" ] }, { "text": "Several case reports describe antibiotics failing to cure the cyst or abscess, with surgery needed afterward, including in locations outside the usual spot.", "studyIds": [ "pmid:30936332", "pmid:18369307" ] }, { "text": "The studies span 1985 to 2018 and use different antibiotics, doses, and surgical techniques, which makes it difficult to directly compare their results.", "studyIds": [ "pmid:29433863", "pmid:22595842", "pmid:16362397", "pmid:9574192", "pmid:2683535", "pmid:4027539" ] } ], "risks": [ { "text": "One trial found that placing antibiotics directly in the surgical wound was linked to lower healing rates and more wound complications than not using antibiotics.", "studyIds": [ "pmid:9574192" ], "severity": "serious" }, { "text": "Another trial found that a single dose of antibiotic before surgery led to significantly more wound infections afterward than a longer course.", "studyIds": [ "pmid:16362397" ], "severity": "serious" }, { "text": "Case reports describe people trying antibiotics for months or years without the cyst or abscess clearing, meaning time was spent on a treatment that didn't work before surgery finally resolved it.", "studyIds": [ "pmid:30936332", "pmid:18369307" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "A pill feels like an easier, less scary first step than a drainage procedure or surgery." }, { "text": "A pilonidal cyst looks and feels like an ordinary skin infection, so antibiotics seem like the obvious treatment." }, { "text": "People hope to avoid the pain and downtime of having an abscess cut open and drained." }, { "text": "A doctor or urgent care may prescribe antibiotics first, before referring someone on for a surgical opinion." } ], "keyStudies": [ "pmid:29433863", "pmid:9574192", "pmid:16362397", "pmid:22595842", "pmid:20734046", "pmid:7850048", "pmid:30463753", "pmid:18369307" ], "studies": [ { "id": "pmid:41340801", "pmid": "41340801", "doi": "10.20471/acc.2025.64.01.17", "nctId": null, "pmcid": "PMC12671715", "title": "LASER SURGERY FOR PILONIDAL DISEASE - A NOVEL MINIMALLY INVASIVE PROCEDURE", "firstAuthor": "Grgić", "multipleAuthors": true, "journal": "Acta Clin Croat", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease in the acute abscess phase", "intervention": "antibiotic therapy together with surgical incision and draining the pus", "comparator": "", "primaryOutcome": "", "result": "the abstract only states that incision with pus evacuation plus antibiotics is 'enough' in the acute phase, without giving outcome data or comparing antibiotics alone", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a background statement in a narrative review about laser surgery, not a study that tested antibiotics and reported results.", "directness": "indirect", "limitations": "abstract gives no study design, no patient numbers, no outcome measures or comparison for antibiotic treatment; it is a general background claim within a review focused on a different (laser) technique.", "followUp": "", "plainFinding": "No actual data on antibiotics given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41340801/", "sourceText": "Pilonidal disease (PD) is a common inflammatory disease of the gluteal region with an incidence of 26/100000 and usually occurs in young males (15-30 years old). The etiology of pilonidal disease is unclear, but literature describes a wide range of factors such as keratin plugs, foreign substance reaction related to hairs, as well as dermatopathy and debris in hair follicles in the natal cleft. PD and also its classic treatment can cause discomfort and very much deteriorate the patient's quality of life. There are many possibilities (conservative or surgical) in the treatment of pilonidal disease, but there is no gold standard. In the acute phase (abscess), surgical incision with pus evacuation and antibiotic therapy is enough. In the chronic phase, there are many possibilities like phenol treatment, surgical excision with lay open and secondary wound healing. There are many reconstructive techniques such as Karydakis, V-Y flap or Limberg flap. A recently minimally invasive technique such as endoscopic surgical procedure or filling pilonidal tract with fibrin glue or phenol have been introduced. We present our experience with laser treatment (Biolitec, Germany) of pilonidal sinus disease.", "provenance": [ { "field": "population", "quote": "Pilonidal disease (PD) is a common inflammatory disease of the gluteal region" }, { "field": "intervention", "quote": "In the acute phase (abscess), surgical incision with pus evacuation and antibiotic therapy is enough." }, { "field": "result", "quote": "In the acute phase (abscess), surgical incision with pus evacuation and antibiotic therapy is enough." } ] }, { "id": "pmid:39875233", "pmid": "39875233", "doi": "10.1016/j.jviscsurg.2024.12.005", "nctId": null, "pmcid": null, "title": "Management of pilonidal sinus and recurrences in 2025", "firstAuthor": "Darnis", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People with pilonidal sinus that can develop into abscess or suppuration", "intervention": "Antibiotics given as part of medical treatment (with analgesics and local antiseptics) during an abscess flare", "comparator": "Emergency incision and drainage surgery for the abscess", "primaryOutcome": "", "result": "The abstract only states that antibiotics are sometimes used as part of medical treatment for abscess or suppuration, alongside analgesics and antiseptics, as an alternative to surgical drainage; it gives no data on whether antibiotics actually clear the abscess", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review mentioning antibiotics only in passing, with no study data, comparison group, or outcome measurements for antibiotic treatment.", "directness": "indirect", "limitations": "The abstract does not report any original data, patient numbers, or outcomes specifically for antibiotic treatment; it is a broad overview of surgical management of pilonidal disease.", "followUp": "", "plainFinding": "No evidence given on antibiotics alone.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39875233/", "sourceText": "Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration. This lesion corresponds histologically to a granuloma that organizes around foreign bodies, most often hairs, and fistulizes to the skin through partially epithelialized orifices. If suppuration and abscess develop, treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room. This is performed in more than 10,000 patients per year in France. Outside of emergencies, elective surgery for pilonidal sinus is indicated to treat bothersome symptoms or to avoid the risk of recurrent abscess. The surgical indication must take into account the patient's risk factors, particularly active smoking, that increase the risk of postoperative complications and recurrence. Elective intervention is performed on more than 30,000 patients per year in France. Radical excision followed by secondary healing is the most commonly performed option. This strategy carries a risk of failure or recurrence for at least 10% of patients. Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications. Midline closure should be avoided, in favor of paramedian or flap closure. Minimally invasive techniques are being developed that combine the extraction of foreign bodies and mechanical debridement or thermal or chemical cautery of the granulomatous walls. They avoid complex and unpleasant nursing care of secondarily healing wounds, at the cost of a recurrence rate equivalent to that from excision techniques. They have the merit of avoiding difficult situations of failure to heal or recurrence after radical excision that are associated with a clear deterioration in the quality of life. The treatment of surgical failures is complex, and combines comprehensive patient care (smoking cessation, anti-infectious treatments, treatment of excess weight, avoidance of a sedentary lifestyle) and often a repeat operation. Minimally invasive treatments, particularly laser treatments, have their place in these difficult situations.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration." }, { "field": "intervention", "quote": "medical treatment combining analgesics, local antiseptics and sometimes antibiotics" }, { "field": "comparator", "quote": "emergency incision and drainage in the operating room" }, { "field": "result", "quote": "If suppuration and abscess develop, treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room." } ] }, { "id": "pmid:38677816", "pmid": "38677816", "doi": "10.1016/j.suc.2023.11.003", "nctId": null, "pmcid": null, "title": "Management of Pilonidal Disease and Hidradenitis Suppurativa", "firstAuthor": "Singh", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "Young adults with pilonidal disease or hidradenitis suppurativa", "intervention": "Hair removal, surgery, topical treatments, antibiotics, biologics", "comparator": "", "primaryOutcome": "", "result": "", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review without data or specific study results on antibiotics for pilonidal disease.", "directness": "indirect", "limitations": "No specific data, outcomes, or comparisons are reported; general overview of management strategies for two different conditions.", "followUp": "", "plainFinding": "No specific findings reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38677816/", "sourceText": "Pilonidal disease and hidradenitis suppurativa affect healthy young adults, causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner. Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered. Hidradenitis suppurativa can be a morbid and challenging disease process. Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considered in severe or refractory cases of the disease.", "provenance": [ { "field": "population", "quote": "Pilonidal disease and hidradenitis suppurativa affect healthy young adults" }, { "field": "intervention", "quote": "Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered." }, { "field": "intervention", "quote": "Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considered in severe or refractory cases of the disease." } ] }, { "id": "pmid:30936332", "pmid": "30936332", "doi": "10.1136/bcr-2018-227381", "nctId": null, "pmcid": "PMC6453299", "title": "Pilonidal abscess of the breast", "firstAuthor": "Keighley", "multipleAuthors": true, "journal": "BMJ Case Rep", "year": 2019, "design": "case-series", "n": 1, "nField": "reported", "population": "a periareolar pilonidal abscess in the breast of a 52-year-old woman", "intervention": "antibiotic therapy and needle aspiration", "comparator": "surgical excision after antibiotics failed", "primaryOutcome": "resolution of the abscess", "result": "the abscess recurred despite antibiotics and needle aspiration, so surgery was needed", "resultDirection": "no-benefit", "quality": "very-low", "qualityWhy": "this is a single case report of an unusual breast location, so it can't tell us much about typical pilonidal abscesses.", "directness": "indirect", "limitations": "single case report; abscess located in the breast rather than the usual natal cleft site, making it an atypical presentation", "followUp": "", "plainFinding": "Antibiotics failed, needed surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30936332/", "sourceText": "Pilonidal disease is a common condition, typically occurring in the natal cleft of adult males. Other sites of pilonidal sinus are rarely reported. We report a case of periareolar pilonidal abscess in the breast of a 52-year-old woman who presented via the breast clinic complaining of nipple inversion and pain. Clinical examination and imaging revealed an underlying abscess which recurred despite antibiotic therapy and needle aspiration; the patient therefore underwent surgical excision of the abscess cavity. Subsequent histology diagnosed pilonidal abscess, an important differential to consider in the case of breast abscess, particularly in cases that are slow to resolve or recur post-treatment.", "provenance": [ { "field": "population", "quote": "We report a case of periareolar pilonidal abscess in the breast of a 52-year-old woman" }, { "field": "n", "quote": "We report a case of periareolar pilonidal abscess in the breast of a 52-year-old woman" }, { "field": "intervention", "quote": "antibiotic therapy and needle aspiration" }, { "field": "comparator", "quote": "the patient therefore underwent surgical excision of the abscess cavity" }, { "field": "primaryOutcome", "quote": "an underlying abscess which recurred despite antibiotic therapy and needle aspiration" }, { "field": "result", "quote": "Clinical examination and imaging revealed an underlying abscess which recurred despite antibiotic therapy and needle aspiration; the patient therefore underwent surgical excision of the abscess cavity." } ] }, { "id": "pmid:30463753", "pmid": "30463753", "doi": "10.1016/j.jss.2018.06.071", "nctId": null, "pmcid": null, "title": "Recurrence of Pilonidal Disease: Our Best is Not Good Enough", "firstAuthor": "Halleran", "multipleAuthors": true, "journal": "J Surg Res", "year": 2018, "design": "retrospective", "n": 307, "nField": "reported", "population": "patients with pilonidal disease treated by pediatric surgeons, median age 16", "intervention": "initial treatment with surgical excision or incision and drainage and/or antibiotics", "comparator": "different initial treatment types (surgery vs. incision/drainage/antibiotics)", "primaryOutcome": "recurrence of pilonidal disease requiring further treatment", "result": "overall recurrence rate was 33%, with most recurrences within the first year; obesity was the only factor linked to recurrence", "resultDirection": "unclear", "quality": "low", "qualityWhy": "it's a retrospective single-center chart review that lumps antibiotics with incision and drainage, so it can't show whether antibiotics alone worked.", "directness": "indirect", "limitations": "retrospective design, antibiotics not analyzed separately from incision and drainage, single center", "followUp": "", "plainFinding": "Doesn't show if antibiotics work.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30463753/", "sourceText": "BACKGROUND: Recurrence rates of pilonidal disease have been reported to be high as 30%. Patients with recurrent pilonidal disease often develop chronic wounds and draining sinuses that incur long-term morbidity, disability, and decreased quality of life. The aim of this study was to characterize rates of recurrence in patients with pilonidal disease treated by pediatric surgeons. METHODS: A single center retrospective review of patients with pilonidal disease evaluated by pediatric surgeons from 2010 to 2015 was performed. Recurrence of pilonidal disease was defined as an episode of active pilonidal disease that required medical or surgical intervention >30 days from the preceding treatment. Repeated events proportional hazards regression modeling was performed to identify factors associated with time to recurrence. RESULTS: Among 307 patients treated for pilonidal disease, nearly 50% were male, and the median age at initial evaluation was 16 years (IQR 15-17). Approximately 45% were obese (BMI ≥ 95th percentile). The initial treatment during the study period was surgical excision in two-thirds and incision and drainage and/or antibiotics in one-third. The overall recurrence rate was 33%, with the majority of recurrences (80%) occurring within the first year. On multivariable analysis, obese BMI was the only factor independently associated with time to disease recurrence. CONCLUSIONS: Pilonidal disease has a substantial recurrence rate even after surgical excision. Future studies investigating treatments that can prevent disease recurrence are needed.", "provenance": [ { "field": "n", "quote": "Among 307 patients treated for pilonidal disease" }, { "field": "population", "quote": "patients with pilonidal disease evaluated by pediatric surgeons from 2010 to 2015" }, { "field": "intervention", "quote": "The initial treatment during the study period was surgical excision in two-thirds and incision and drainage and/or antibiotics in one-third." }, { "field": "comparator", "quote": "surgical excision in two-thirds and incision and drainage and/or antibiotics in one-third" }, { "field": "primaryOutcome", "quote": "Recurrence of pilonidal disease was defined as an episode of active pilonidal disease that required medical or surgical intervention >30 days from the preceding treatment." }, { "field": "result", "quote": "The overall recurrence rate was 33%, with the majority of recurrences (80%) occurring within the first year." } ] }, { "id": "pmid:29433863", "pmid": "29433863", "doi": "10.1016/j.jss.2017.09.051", "nctId": null, "pmcid": null, "title": "Aspiration for acute pilonidal abscess-a cohort study", "firstAuthor": "Lasithiotakis", "multipleAuthors": true, "journal": "J Surg Res", "year": 2018, "design": "prospective-cohort", "n": 100, "nField": "reported", "population": "adults and teens with a sudden pilonidal abscess (boil near the tailbone)", "intervention": "draining the abscess with a needle (aspiration) plus a week of oral antibiotics (cefalexin and metronidazole)", "comparator": "no direct comparison group in this study; traditional open incision and drainage mentioned only as background", "primaryOutcome": "whether the abscess resolved without needing surgical incision and drainage, and patient satisfaction", "result": "it is effective in 83%, and it is associated with high overall satisfaction rates", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a single-group study without a comparison group, with excluded higher-risk patients and only a 56% survey response rate, so it can't prove antibiotics alone caused the improvement.", "directness": "direct", "limitations": "no control group, selective patient inclusion (excluded immunosuppressed, diabetic, or more severe cases), and low questionnaire response rate (56 of 100 patients).", "followUp": "29 (47) months", "plainFinding": "Avoided surgery in most patients.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29433863/", "sourceText": "BACKGROUND: The traditional open incision and drainage of a pilonidal abscess is associated with slow healing and delayed return to normal daily activities. The aim of this study is to assess safety, effectiveness, and patient satisfaction of aspiration followed by antibiotics for a pilonidal abscess. MATERIAL AND METHODS: All patients presenting with an acute pilonidal abscess during the period December 2010 and December 2014 in York Hospital, UK, were treated with bedside aspiration under local anesthetic, followed by oral cefalexin and metronidazole for 7 days. Patients with immunosuppression, diabetes, overlying skin necrosis, and perforation were excluded. Complications of the procedure were prospectively recorded. Long-term outcomes and overall patients' satisfaction were assessed with the use of mailed questionnaires and Visual Analogue Scales (VAS) (0 = not satisfied at all, 10 = very satisfied). RESULTS: One hundred sixty-nine patients presented with an acute pilonidal abscess and a total of 100 patients were treated with aspiration and antibiotics. There were 50 women (50%) and the median (interquartile range [IQR]) age of the cohort was 24 (14) years. Eleven patients had a history of a previous pilonidal procedure. Seven patients were treated successfully with a reaspiration. Overall, 10 patients required incision and drainage after a median (IQR) follow-up time of 29 (47) months. Fifty-six patients returned completed questionnaires. The median (IQR) of the VAS for the overall satisfaction of the procedure was 9 (5). CONCLUSIONS: Aspiration of a pilonidal abscess in selected patients is effective in 83%, and it is associated with high overall satisfaction rates.", "provenance": [ { "field": "population", "quote": "All patients presenting with an acute pilonidal abscess during the period December 2010 and December 2014 in York Hospital, UK" }, { "field": "intervention", "quote": "treated with bedside aspiration under local anesthetic, followed by oral cefalexin and metronidazole for 7 days" }, { "field": "comparator", "quote": "The traditional open incision and drainage of a pilonidal abscess is associated with slow healing and delayed return to normal daily activities." }, { "field": "primaryOutcome", "quote": "The aim of this study is to assess safety, effectiveness, and patient satisfaction of aspiration followed by antibiotics for a pilonidal abscess." }, { "field": "result", "quote": "Aspiration of a pilonidal abscess in selected patients is effective in 83%, and it is associated with high overall satisfaction rates." }, { "field": "n", "quote": "a total of 100 patients were treated with aspiration and antibiotics" }, { "field": "followUp", "quote": "after a median (IQR) follow-up time of 29 (47) months" } ] }, { "id": "pmid:27383814", "pmid": "27383814", "doi": "10.1089/sur.2015.207", "nctId": null, "pmcid": null, "title": "Effect of Triclosan-Coated Suture and Antibiotic Prophylaxis on Infection and Recurrence after Karydakis Flap Repair for Pilonidal Disease: A Randomized Parallel-Arm Double-Blinded Clinical Trial", "firstAuthor": "Karip", "multipleAuthors": true, "journal": "Surg Infect (Larchmt)", "year": 2016, "design": "rct", "n": null, "nField": "not-reported", "population": "people having surgery to repair pilonidal sinus disease (Karydakis flap procedure)", "intervention": "antibiotic prophylaxis before/after surgery, with triclosan-coated sutures", "comparator": "no antibiotic prophylaxis, and/or conventional (non-coated) sutures", "primaryOutcome": "rate of wound infection and recurrence after surgery", "result": "the no-antibiotic group had to be stopped early because of unacceptably high infection rates; the two suture types did not differ significantly in infection or recurrence", "resultDirection": "mixed", "quality": "low", "qualityWhy": "one treatment arm was stopped early for safety, the total number of patients is not clearly stated, and the study is about preventing infection after surgery rather than treating an existing abscess.", "directness": "indirect", "limitations": "AP(-) arm terminated prematurely due to high infection rates, exact total sample size not given, follow-up limited to six months, and the question studied (prophylaxis during surgery) differs from treating an active cyst/abscess with antibiotics alone", "followUp": "six-month follow-up", "plainFinding": "Antibiotics prevented surgical wound infection, not abscess cure", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27383814/", "sourceText": "BACKGROUND: Pilonidal sinus disease was first described by Mayo in 1833 as \"a cyst that contains hair.\" Although surgical treatment of the lesions can have successful outcomes, it also can be associated with relatively high rates of post-operative infectioins and recurrence. Many studies have demonstrated that triclosan-coated sutures (TCS) decrease surgical site infections. OBJECTIVE: The goal of this randomized parallel-arm double-blind clinical trial was to investigate the ability of antibiotic prophylaxis, and secondarily of antibiotic-coated sutures, to prevent post-operative infections in the surgical management of pilonidal sinus disease. PATIENTS AND METHODS: The initial trial protocol aimed to compare early infections in patients who did and did not undergo antibiotic prophylaxis (AP(+) vs. AP(-)). A secondary goal was to compare the effects of TCS and conventional sutures (CS) on early infectious complication rates in the two groups. The AP(-) arm had to be terminated prematurely because of an unacceptably high rate of infectious complications. RESULTS: A total of 80 micro-organisms were recovered from 74 patients (69.8%). Methicillin-susceptible coagulase-negative staphylococci were the most common isolates (30%). The most frequently detected anaerobic micro-organism was Actinomyces israelii (7.5%). The TCS and CS groups had similar rates of micro-organism growth (65.8% vs. 75.0%). There was no significant difference in the occurrence of wound dehiscence. Over the six-month follow-up, there were two recurrences, both in the TCS group. The difference was not significant. CONCLUSIONS: We believe that antibiotic prophylaxis is necessary in patients scheduled for Karydakis flap repair. In our study, TCS tended to be associated with a lower rate of infection, but this trend did not achieve statistical significance. Anaerobic micro-organisms dominated the infective isolates.", "provenance": [ { "field": "population", "quote": "surgical management of pilonidal sinus disease" }, { "field": "intervention", "quote": "antibiotic prophylaxis, and secondarily of antibiotic-coated sutures, to prevent post-operative infections" }, { "field": "comparator", "quote": "compare early infections in patients who did and did not undergo antibiotic prophylaxis (AP(+) vs. AP(-))" }, { "field": "primaryOutcome", "quote": "to prevent post-operative infections in the surgical management of pilonidal sinus disease" }, { "field": "result", "quote": "The AP(-) arm had to be terminated prematurely because of an unacceptably high rate of infectious complications." }, { "field": "result", "quote": "There was no significant difference in the occurrence of wound dehiscence." }, { "field": "followUp", "quote": "Over the six-month follow-up, there were two recurrences, both in the TCS group." }, { "field": "n", "quote": "A total of 80 micro-organisms were recovered from 74 patients (69.8%)." } ] }, { "id": "pmid:25541849", "pmid": "25541849", "doi": "10.5505/tjtes.2014.62547", "nctId": null, "pmcid": null, "title": "Comparison of early surgery (unroofing-curettage) and elective surgery (Karydakis flap technique) in pilonidal sinus abscess cases", "firstAuthor": "Kanat", "multipleAuthors": true, "journal": "Ulus Travma Acil Cerrahi Derg", "year": 2014, "design": "retrospective", "n": 53, "nField": "reported", "population": "patients treated for pilonidal sinus abscesses", "intervention": "early (acute) period local surgical intervention (unroofing-curettage) followed by dressing and secondary healing", "comparator": "surgery performed in elective conditions (pilonidal sinus excision and Karydakis flap) following conventional abscess treatment (drainage-antibiotic therapy)", "primaryOutcome": "complication rate, recurrence rate, and treatment duration", "result": "a significant difference was not found between the groups in terms of complication development and recurrence. However, there was a statistically significant difference between the groups in terms of treatment duration", "resultDirection": "mixed", "quality": "low", "qualityWhy": "small retrospective study comparing two surgical strategies rather than testing antibiotics alone, so it offers only indirect evidence about antibiotics' effect.", "directness": "indirect", "limitations": "retrospective design, small sample size, and antibiotics were only one part of a combined drainage-antibiotic treatment, not tested alone", "followUp": "14 months", "plainFinding": "Surgery approach compared, not antibiotics alone", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25541849/", "sourceText": "BACKGROUND: The aim of this study is to compare the effectiveness and success of early (acute) period local surgical intervention (unroofing-curettage) followed by dressing and secondary healing with the surgery performed in elective conditions (pilonidal sinus excision and Karydakis flap) following conventional abscess treatment (drainage-antibiotic therapy) in pilonidal sinus abscess cases. METHODS: The data of the patients treated for pilonidal sinus abscesses in our clinic between January 2012 and March 2013 were analyzed, retrospectively. Those who had early surgery were determined as Group S, and those who had elective surgery following drainage-antibiotic therapy were determined as Group K. Patients in both groups were compared in terms of age, gender, complications, recurrence rate and healing time. Patients were followed for an average of 14 months. RESULTS: Of the 53 patients included in the study, 28 were in Group S and 25 in Group K. The mean age and gender distribution of both groups were similar and a significant difference was not found between the groups in terms of complication development and recurrence. However, there was a statistically significant difference between the groups in terms of treatment duration (p=0.02). CONCLUSION: In treating acute pilonidal abscesses, the Karydakis method, following drainage-antibiotic therapy, is a preferable method due to its shorter treatment duration and higher patient comfort.", "provenance": [ { "field": "n", "quote": "Of the 53 patients included in the study, 28 were in Group S and 25 in Group K." }, { "field": "population", "quote": "patients treated for pilonidal sinus abscesses in our clinic" }, { "field": "intervention", "quote": "early (acute) period local surgical intervention (unroofing-curettage) followed by dressing and secondary healing" }, { "field": "comparator", "quote": "surgery performed in elective conditions (pilonidal sinus excision and Karydakis flap) following conventional abscess treatment (drainage-antibiotic therapy)" }, { "field": "primaryOutcome", "quote": "Patients in both groups were compared in terms of age, gender, complications, recurrence rate and healing time." }, { "field": "result", "quote": "a significant difference was not found between the groups in terms of complication development and recurrence. However, there was a statistically significant difference between the groups in terms of treatment duration" }, { "field": "followUp", "quote": "Patients were followed for an average of 14 months." } ] }, { "id": "pmid:22595842", "pmid": "22595842", "doi": "10.1097/DCR.0b013e31824b9527", "nctId": null, "pmcid": null, "title": "Converting emergency pilonidal abscess into an elective procedure", "firstAuthor": "Hussain", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2012, "design": "prospective-cohort", "n": 40, "nField": "reported", "population": "patients with sudden pilonidal abscess (not septic, diabetic, or immune-compromised)", "intervention": "needle aspiration of the abscess plus oral antibiotics", "comparator": "no comparator group; outcomes tracked after aspiration and antibiotics", "primaryOutcome": "days to return to normal activity, response to treatment, and leftover inflammation", "result": "38 of 40 patients had complete resolution of acute inflammation and were back to normal activities the next day; 2 did not respond and needed incision and drainage", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-center study without a comparison group, so it can't show whether antibiotics alone (without aspiration) would work.", "directness": "indirect", "limitations": "No control group; antibiotics were combined with needle aspiration, so the antibiotic effect alone cannot be separated out; one non-responder had not received appropriate antibiotics.", "followUp": "median of 5 days", "plainFinding": "Mostly resolved with drainage plus antibiotics.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22595842/", "sourceText": "BACKGROUND: Improvements in outcome after surgery for elective pilonidal sinus disease have yet to be matched for those presenting with acute disease. Traditional approaches to the management of acute pilonidal abscess have been associated with slow healing and significant loss of working time. OBJECTIVE: The aim of this study was to report our approach in which a temporizing intervention allows subsequent definitive treatment with low morbidity. DESIGN: This article presents a prospective cohort study. SETTING: This study was performed in acute admissions to the Surgical Unit in York Teaching Hospital. PATIENTS: Patients presenting with acute pilonidal abscess, not septic, immune-compromised, or diabetic, and without skin necrosis, underwent aspiration on the surgical ward. INTERVENTION: Aspiration of pilonidal abscess under local anesthetic was performed with the use of a wide-bore needle. The abscess cavity was drained to dryness, samples were sent to the laboratory for microbiology, and empirical oral antibiotics were commenced, covering anaerobes and aerobes. Review was arranged for within 7 days to plan elective excision and primary closure of the underlying pilonidal sinus. MAIN OUTCOME MEASURES: The primary outcomes measured were the number of days required to return to normal activities, response to treatment, and any residual inflammation. RESULTS: Fifty-six patients were referred with acute pilonidal abscess. Forty patients met the criteria for aspiration and empirical antibiotic treatment. All were allowed to go home the same day and were reviewed within a median of 5 days. Thirty-eight (38/40) patients demonstrated complete resolution of acute inflammation and were back to normal activities the following day. Fifteen patients subsequently underwent day-case excision and primary closure at a median of 9 weeks. Another 13 are awaiting surgery, and 10 patients have declined further treatment. Two (2/40) patients did not respond, one of whom did not receive the appropriate antibiotics. Both were managed with incision and drainage. CONCLUSIONS: Aspiration and antibiotic management of pilonidal abscess is effective in 95% of acute cases in preventing the need for emergent laying open and allows for subsequent elective surgery.", "provenance": [ { "field": "n", "quote": "Forty patients met the criteria for aspiration and empirical antibiotic treatment." }, { "field": "population", "quote": "Patients presenting with acute pilonidal abscess, not septic, immune-compromised, or diabetic, and without skin necrosis, underwent aspiration on the surgical ward." }, { "field": "intervention", "quote": "Aspiration of pilonidal abscess under local anesthetic was performed with the use of a wide-bore needle. The abscess cavity was drained to dryness, samples were sent to the laboratory for microbiology, and empirical oral antibiotics were commenced, covering anaerobes and aerobes." }, { "field": "comparator", "quote": "This article presents a prospective cohort study." }, { "field": "primaryOutcome", "quote": "The primary outcomes measured were the number of days required to return to normal activities, response to treatment, and any residual inflammation." }, { "field": "result", "quote": "Thirty-eight (38/40) patients demonstrated complete resolution of acute inflammation and were back to normal activities the following day." }, { "field": "result", "quote": "Two (2/40) patients did not respond, one of whom did not receive the appropriate antibiotics." }, { "field": "followUp", "quote": "were reviewed within a median of 5 days" } ] }, { "id": "pmid:21999659", "pmid": "21999659", "doi": "10.1111/j.1742-481X.2011.00874.x", "nctId": null, "pmcid": "PMC7950616", "title": "Development of an evidence-based protocol for care of pilonidal sinus wounds healing by secondary intent using a modified reactive Delphi procedure. Part one: the literature review*", "firstAuthor": "Harris", "multipleAuthors": true, "journal": "Int Wound J", "year": 2012, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus wounds healing by secondary intent (open wounds, not closed surgically)", "intervention": "various wound care approaches including systemic antibiotics, topical antiseptics, dressings, and other interventions", "comparator": "", "primaryOutcome": "whether evidence-based guidelines exist for caring for these wounds and what factors affect healing", "result": "the review found no best practice guidelines for these wounds and identified systemic antibiotics as just one of seventeen areas of interest needing further study, without giving a finding on whether antibiotics work", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a literature review aimed at building a questionnaire for future consensus work, not a study testing whether antibiotics work, so it gives no usable evidence on effectiveness.", "directness": "indirect", "limitations": "abstract states review found no best practice guidelines and only one clinical pathway; it does not report any actual outcome data on antibiotic use, just that it is a topic needing exploration", "followUp": "", "plainFinding": "No evidence reported either way.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21999659/", "sourceText": "This article is in two parts. The overall aim of this section was to review the literature in relation to pilonidal sinus wounds (PSW) healing by secondary intent for a Master's of Science in Wound Healing and Tissue Repair thesis. The purpose of the literature review was to determine if an evidence-based guideline or consensus document existed for the care of these wounds, and if not, to determine the topics from which to develop items for the first round of a modified reactive Delphi questionnaire. Part two will describe the iterative process, the analysis and the results. The review found no best practice guidelines concerning PSW, and only one clinical pathway. Seventeen areas of interest were identified that may contribute to optimal healing conditions or to delayed healing. These included microbiology of infected PSW, signs and symptoms of localised or deeper (spreading) chronic wound infection, swab for c&s, role of topical antiseptics or antimicrobials, systemic antibiotics, local wound interventions, optimal positioning, wound cleansing, principles of moist wound healing/dressing selection, topical negative pressure (TNP) therapy, peri-wound skin decontamination and depilation, pain control, physical activities, optimal nutrition and patient education.", "provenance": [ { "field": "population", "quote": "pilonidal sinus wounds (PSW) healing by secondary intent" }, { "field": "intervention", "quote": "systemic antibiotics" }, { "field": "primaryOutcome", "quote": "to determine if an evidence-based guideline or consensus document existed for the care of these wounds" }, { "field": "result", "quote": "The review found no best practice guidelines concerning PSW, and only one clinical pathway." }, { "field": "result", "quote": "Seventeen areas of interest were identified that may contribute to optimal healing conditions or to delayed healing." } ] }, { "id": "pmid:20819439", "pmid": "20819439", "doi": "10.1177/147323001003800329", "nctId": null, "pmcid": null, "title": "Effect of gentamicin-absorbed collagen in wound healing in pilonidal sinus surgery: a prospective randomized study", "firstAuthor": "Yetim", "multipleAuthors": true, "journal": "J Int Med Res", "year": 2010, "design": "rct", "n": 80, "nField": "reported", "population": "patients having surgery to remove a pilonidal sinus", "intervention": "gentamicin-soaked collagen sponge placed in the wound, with no oral antibiotics afterward", "comparator": "oral antibiotics for 7 days after surgery", "primaryOutcome": "wound healing time, infection rate, recurrence rate, and length of hospital stay", "result": "the group with the local gentamicin sponge healed faster, had less infection and recurrence, and shorter hospital stays than the group given oral antibiotics", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a randomized trial but small, single-center, and does not describe blinding or how infection/recurrence were measured.", "directness": "indirect", "limitations": "abstract does not report blinding, follow-up duration, or statistical details beyond 'significant'", "followUp": "", "plainFinding": "Local antibiotic sponge beat oral pills", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20819439/", "sourceText": "Pilonidal sinus is a common disease that causes the loss of many working hours, but treatment is variable and problematic. The effect of gentamicin-absorbed collagen on healing, infection and recurrence, and length of hospital stay were examined after pilonidal sinus surgery. Patients undergoing surgical treatment for pilonidal sinus were randomly assigned into two groups each of 40 patients. Both groups were treated with excision and primary closure under local anaesthesia. Group 1 (control) received oral antibiotics for 7 days post-operatively. In group 2, prior to wound closure, gentamicin-absorbed collagen sponges were placed on the sacral fascia and these patients did not receive oral post-operative antibiotic therapy. Patients in group 2 had a significantly shorter mean wound healing time, significantly lower infection and recurrence rates, and a significantly shorter hospital stay than those in group 1. It is concluded that implantation of a gentamicin-containing collagen sponge on the wound area in pilonidal sinus decreased the rates of infection and recurrence, and shortened the hospital stay.", "provenance": [ { "field": "n", "quote": "randomly assigned into two groups each of 40 patients" }, { "field": "population", "quote": "Patients undergoing surgical treatment for pilonidal sinus" }, { "field": "intervention", "quote": "gentamicin-absorbed collagen sponges were placed on the sacral fascia and these patients did not receive oral post-operative antibiotic therapy" }, { "field": "comparator", "quote": "Group 1 (control) received oral antibiotics for 7 days post-operatively" }, { "field": "primaryOutcome", "quote": "The effect of gentamicin-absorbed collagen on healing, infection and recurrence, and length of hospital stay were examined after pilonidal sinus surgery" }, { "field": "result", "quote": "Patients in group 2 had a significantly shorter mean wound healing time, significantly lower infection and recurrence rates, and a significantly shorter hospital stay than those in group 1" } ] }, { "id": "pmid:20734046", "pmid": "20734046", "doi": "10.1007/s00268-010-0763-2", "nctId": null, "pmcid": null, "title": "Local administration of antibiotics by gentamicin-collagen sponge does not improve wound healing or reduce recurrence rate after pilonidal excision with primary suture: a prospective randomized controlled trial", "firstAuthor": "Andersson", "multipleAuthors": true, "journal": "World J Surg", "year": 2010, "design": "rct", "n": 161, "nField": "reported", "population": "patients with symptomatic pilonidal disease undergoing surgery", "intervention": "gentamicin antibiotic sponge placed in wound before closure", "comparator": "wound closure with no additional treatment", "primaryOutcome": "wound healing, infection, and recurrence rates", "result": "no significant differences in wound healing, infection, or recurrence between groups", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized multi-center trial but the differences found were not statistically significant and some trends favored the control group.", "directness": "indirect", "limitations": "study tests antibiotic use alongside surgery to prevent infection, not antibiotics alone treating an existing abscess or cyst", "followUp": "1 year", "plainFinding": "No benefit over surgery alone", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20734046/", "sourceText": "BACKGROUND: Excision and primary suture for pilonidal disease is associated with a high rate of wound infection and recurrences. This randomized, controlled study was designed to analyze the effect of local application of a gentamicin-containing collagen sponge (Collatamp(®)) in reducing the wound infection rate and recurrences after excision of pilonidal sinus and wound closure with primary midline suture. METHODS: From March 2003 to November 2005, 161 patients with symptomatic pilonidal disease were operated on at 11 hospitals with traditional wide excision of the sinus and all of its tracts. The patients were randomized to filling of the cavity with a gentamicin-containing collagen sponge (Collatamp(®)) before wound closure or to closure with no additional treatment. Information about the treatment allocation was hidden until the end of the study. Information about wound healing was noted at follow-up at the outpatient department after 2-4 days, 2 weeks, 3 months, and 1 year. RESULTS: No statistically significant differences were observed between the groups during follow-up. Patients who received prophylaxis with Collatamp(®) had slightly fewer wounds with exudate at 2-4 days and 2 weeks of follow-up (2% vs. 10%, p = 0.051 and 57% vs. 65%, p = 0.325, respectively), a slightly larger proportion of healed wounds at 3 months follow-up (77% vs. 66%, p = 0.138) but not at 1 year (85% vs. 90%, p = 0.42, respectively), and slightly more reoperations (10% vs. 4%, p = 0.213). CONCLUSIONS: This randomized, controlled study showed no significant differences in the rates of wound infection, wound healing, and recurrences when a gentamicin-collagen sponge was added to the surgical treatment of pilonidal disease with excision and primary midline suture. This does not support the use of gentamicin-collagen sponge for the surgical treatment of pilonidal disease.", "provenance": [ { "field": "population", "quote": "161 patients with symptomatic pilonidal disease were operated on at 11 hospitals" }, { "field": "intervention", "quote": "filling of the cavity with a gentamicin-containing collagen sponge (Collatamp(®)) before wound closure" }, { "field": "comparator", "quote": "closure with no additional treatment" }, { "field": "primaryOutcome", "quote": "designed to analyze the effect of local application of a gentamicin-containing collagen sponge (Collatamp(®)) in reducing the wound infection rate and recurrences" }, { "field": "result", "quote": "This randomized, controlled study showed no significant differences in the rates of wound infection, wound healing, and recurrences when a gentamicin-collagen sponge was added to the surgical treatment of pilonidal disease with excision and primary midline suture." }, { "field": "n", "quote": "161 patients with symptomatic pilonidal disease were operated on at 11 hospitals" }, { "field": "followUp", "quote": "follow-up at the outpatient department after 2-4 days, 2 weeks, 3 months, and 1 year" } ] }, { "id": "pmid:19438999", "pmid": "19438999", "doi": "10.1111/j.1600-0781.2009.00428.x", "nctId": null, "pmcid": null, "title": "Methyl aminolaevulinate photodynamic therapy for the treatment of hidradenitis suppurativa and pilonidal cysts", "firstAuthor": "Saraceno", "multipleAuthors": true, "journal": "Photodermatol Photoimmunol Photomed", "year": 2009, "design": "case-series", "n": 1, "nField": "reported", "population": "a 29-year-old man with hidradenitis suppurativa and pilonidal cysts since age 21", "intervention": "photodynamic therapy with methyl aminolaevulinate cream; prior treatment included antibiotics", "comparator": "the patient's own prior treatment with antibiotics, corticosteroids and retinoids", "primaryOutcome": "clinical improvement of the skin lesions", "result": "the patient had been treated with antibiotics in the past without significant clinical improvement, before later achieving remission with photodynamic therapy", "resultDirection": "no-benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, not a controlled study, so it cannot reliably show whether antibiotics work.", "directness": "indirect", "limitations": "single case report with no control group; antibiotics were only mentioned as a past, unsuccessful treatment before the main therapy (photodynamic therapy) being studied.", "followUp": "6-month follow-up", "plainFinding": "Antibiotics didn't help this patient.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/19438999/", "sourceText": "Hidradenitis suppurativa (HS) and pilonidal cysts are chronic, inflammatory skin conditions involving apocrine gland-bearing skin. Treatment is limited and unsatisfactory. Photodynamic therapy (PDT) has been reported to be safe and effective in the treatment of several off-label skin conditions. We report the case of a 29-year-old man affected by HS and pilonidal cysts since the age of 21. In the past, the patient was treated with antibiotics, corticosteroids and retinoids, without significant clinical improvement. Treatment with methyl aminolaevulinate (MAL)-PDT was started. A topical MAL cream (Metvix) was applied to the affected areas with an occlusive dressing for 3 h and irradiated with a red light source. Therapy was repeated every 15 days for a total of nine applications. The patient completed a 6-month follow-up and achieved an almost complete clinical remission of the skin lesions (80%) and complete resolution of the itching and discomfort. This is the first case of HS associated with pilonidal cysts treated with MAL-PDT. MAL-PDT was effective and well tolerated in our patient. The costs of this therapy represent an important limitation, taking into account the high number of sessions that were performed compared with non-melanoma skin cancers.", "provenance": [ { "field": "n", "quote": "a 29-year-old man" }, { "field": "population", "quote": "a 29-year-old man affected by HS and pilonidal cysts since the age of 21" }, { "field": "intervention", "quote": "In the past, the patient was treated with antibiotics, corticosteroids and retinoids, without significant clinical improvement." }, { "field": "result", "quote": "In the past, the patient was treated with antibiotics, corticosteroids and retinoids, without significant clinical improvement." }, { "field": "primaryOutcome", "quote": "achieved an almost complete clinical remission of the skin lesions (80%) and complete resolution of the itching and discomfort" }, { "field": "comparator", "quote": "In the past, the patient was treated with antibiotics, corticosteroids and retinoids, without significant clinical improvement." } ] }, { "id": "pmid:18369307", "pmid": "18369307", "doi": "10.1097/LGT.0b013e3181579306", "nctId": null, "pmcid": null, "title": "Pilonidal cyst involving the clitoris: a case report", "firstAuthor": "Baker", "multipleAuthors": true, "journal": "J Low Genit Tract Dis", "year": 2008, "design": "case-series", "n": 1, "nField": "reported", "population": "a 30-year-old woman with a chronic draining abscess near the clitoris", "intervention": "antibiotics and local incisions (prior treatment), followed by surgical excision", "comparator": "no formal comparator", "primaryOutcome": "whether the cyst/abscess resolved permanently", "result": "antibiotics and local incisions over about 2 years did not cure it; wide surgical excision achieved healing", "resultDirection": "no-benefit", "quality": "very-low", "qualityWhy": "this is a single case report, so it cannot show whether antibiotics generally work or not.", "directness": "indirect", "limitations": "only one patient, unusual location (clitoral), no control group, retrospective description.", "followUp": "", "plainFinding": "Antibiotics failed; surgery cured it.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18369307/", "sourceText": "BACKGROUND: A periclitoral pilonidal cyst or sinus is an exceedingly infrequent occurrence. Diagnostic criteria consist of a sinus tract or cyst containing hair follicles and inflammatory reaction in one or more partially or completely epithelialized sinus tracts. Follow-up of patients reported in the literature has been too short to provide a consensus in regard to the extent of surgery required to provide permanent cure. CASE: A 30-year-old patient was seen in consultation for evaluation of a chronic, draining periclitoral abscess that had been treated for approximately 2 years with multiple rounds of antibiotics and local incisions. Treatment consisted of a wide local excision of the cyst and multiple sinuses extending into the periclitoral area and labia minora. The shaft and glans of the clitoris were preserved. Primary closure and healing were accomplished. CONCLUSION: Diagnosis and curative therapy of a pilonidal cyst of the clitoris require a thorough resection which can be accomplished with preservation of the clitoris.", "provenance": [ { "field": "n", "quote": "A 30-year-old patient was seen in consultation" }, { "field": "population", "quote": "A 30-year-old patient was seen in consultation for evaluation of a chronic, draining periclitoral abscess" }, { "field": "intervention", "quote": "had been treated for approximately 2 years with multiple rounds of antibiotics and local incisions" }, { "field": "comparator", "quote": "Treatment consisted of a wide local excision of the cyst and multiple sinuses extending into the periclitoral area and labia minora" }, { "field": "primaryOutcome", "quote": "Follow-up of patients reported in the literature has been too short to provide a consensus in regard to the extent of surgery required to provide permanent cure." }, { "field": "result", "quote": "Treatment consisted of a wide local excision of the cyst and multiple sinuses extending into the periclitoral area and labia minora. The shaft and glans of the clitoris were preserved. Primary closure and healing were accomplished." } ] }, { "id": "pmid:16362397", "pmid": "16362397", "doi": "10.1007/s00384-005-0064-7", "nctId": null, "pmcid": null, "title": "Single-dose metronidazole vs 5-day multi-drug antibiotic regimen in excision of pilonidal sinuses with primary closure: a prospective, randomized, double-blinded pilot study", "firstAuthor": "Chaudhuri", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2006, "design": "rct", "n": 50, "nField": "reported", "population": "patients having surgery to remove pilonidal sinuses", "intervention": "a single dose of metronidazole antibiotic given before surgery", "comparator": "a 5-day course of multiple antibiotics (cefuroxime, metronidazole, then oral co-amoxiclav) before and after surgery", "primaryOutcome": "wound infection complications after surgery", "result": "the single-dose antibiotic group had significantly more wound infections at 2 and 4 weeks than the multi-drug group", "resultDirection": "harm", "quality": "low", "qualityWhy": "this is a small pilot trial of only 50 patients, which the authors themselves say is too small to draw firm conclusions from.", "directness": "indirect", "limitations": "small pilot study; authors state it needs to be repeated in a larger number of patients to have statistical power; also studies prophylactic antibiotics around surgery, not antibiotics used to treat an existing cyst/abscess without surgery", "followUp": "4 weeks", "plainFinding": "More wound infections with single dose.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/16362397/", "sourceText": "AIM: To compare infection-related wound complications following excision of pilonidal sinuses with primary closure using either single-dose intravenous (i.v.) administration of metronidazole preoperatively or a broad-spectrum multi-drug regimen. PATIENTS AND METHODS: This is a double-blinded study wherein 50 patients were randomized into receiving either single-drug (metronidazole 500 mg i.v.) prophylaxis preoperatively or multi-drug cover (cefuroxime 1.5 g i.v. and metronidazole 0.5 g i.v. preoperatively, and co-amoxiclav 375 mg orally 8-hourly postoperatively for 5 days). They were reviewed at 1, 2 and 4 weeks postoperatively. Wounds were graded as follows: I, healthy; II, redness and swelling of edges; III, abscess in relation to a suture; IV, spreading wound infection; and V, wound breakdown. Other factors considered were the distance from the lowest wound margin to the anal verge and previous local surgery. RESULTS: Fifty patients (38 men and 12 women, mean age 27 years) underwent pilonidal sinus surgery. At week 1, there was no difference in wound infection rates (p=0.9). However, there were significantly more wound infections in the single-drug group at week 2 (p<0.0001) and week 4 (p=0.03). Seventy-two per cent of all patients had complete wound healing at week 4. Distance from the anal verge and previous surgery did not affect wound infection rates (p> or =0.2). Treating such complications costs 73,219.20 dollars per 100 patients. CONCLUSION: A broad-spectrum 5-day regimen is superior to 'single-shot' antibiotic prophylaxis in preventing infection-related wound complications. However, this study needs to be conducted in a larger number of patients to have statistical power.", "provenance": [ { "field": "n", "quote": "50 patients were randomized" }, { "field": "population", "quote": "underwent pilonidal sinus surgery" }, { "field": "intervention", "quote": "single-drug (metronidazole 500 mg i.v.) prophylaxis preoperatively" }, { "field": "comparator", "quote": "multi-drug cover (cefuroxime 1.5 g i.v. and metronidazole 0.5 g i.v. preoperatively, and co-amoxiclav 375 mg orally 8-hourly postoperatively for 5 days)" }, { "field": "primaryOutcome", "quote": "infection-related wound complications following excision of pilonidal sinuses with primary closure" }, { "field": "result", "quote": "there were significantly more wound infections in the single-drug group at week 2 (p<0.0001) and week 4 (p=0.03)" }, { "field": "followUp", "quote": "reviewed at 1, 2 and 4 weeks postoperatively" }, { "field": "qualityWhy", "quote": "this study needs to be conducted in a larger number of patients to have statistical power" } ] }, { "id": "pmid:9574192", "pmid": "9574192", "doi": null, "nctId": null, "pmcid": null, "title": "[Infected pilonidal sinus]", "firstAuthor": "Brieler", "multipleAuthors": false, "journal": "Langenbecks Arch Chir Suppl Kongressbd", "year": 1997, "design": "rct", "n": 324, "nField": "reported", "population": "Patients with pilonidal sinus disease needing surgery", "intervention": "Antibiotic carrier placed in the wound during surgery", "comparator": "No antibiotic carrier used", "primaryOutcome": "Rate of primary wound healing", "result": "Antibiotic carrier group had lower primary healing (66% vs 69%), more wound complications, and longer hospital stay", "resultDirection": "harm", "quality": "low", "qualityWhy": "Although called randomized, the abstract gives no statistical testing and the antibiotic approach studied is a local wound implant during surgery, not a general antibiotic treatment for infection.", "directness": "indirect", "limitations": "No p-values or statistical analysis reported; study looks at a local antibiotic carrier used during surgical wound closure rather than antibiotics as a stand-alone treatment for an infected cyst or abscess.", "followUp": "", "plainFinding": "No benefit, more wound problems.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/9574192/", "sourceText": "During the past 11 years (1985-1996), 324 patients with pilonidal sinus were treated. In 272 cases primary wound closure was performed, in contrast to 52 cases with secondary wound healing. One hundred and fourteen patients were additionally treated with an antibiotic carrier (group 1), 158 were not (group 2). In group 1 primary healing occurred in only 66% of cases vs 69% in group 2. We found wound complications with a lag time of 4 days in comparison with group 2. Serious wound secretion persisted longer in group 1, resulting in a longer hospital stay of 6.5 days on average. We conclude that the application of antibiotic carriers does not raise the rate of primary wound healing. Better results can be achieved by secondary wound healing appropriate treatment with hydrocolloidal moist wound dressings.", "provenance": [ { "field": "n", "quote": "324 patients with pilonidal sinus were treated" }, { "field": "population", "quote": "324 patients with pilonidal sinus" }, { "field": "intervention", "quote": "One hundred and fourteen patients were additionally treated with an antibiotic carrier (group 1)" }, { "field": "comparator", "quote": "158 were not (group 2)" }, { "field": "primaryOutcome", "quote": "primary healing occurred in only 66% of cases vs 69% in group 2" }, { "field": "result", "quote": "We conclude that the application of antibiotic carriers does not raise the rate of primary wound healing." }, { "field": "result", "quote": "Serious wound secretion persisted longer in group 1, resulting in a longer hospital stay of 6.5 days on average." } ] }, { "id": "pmid:7850048", "pmid": "7850048", "doi": null, "nctId": null, "pmcid": null, "title": "The role of cefoxitin prophylaxis in chronic pilonidal sinus treated with excision and primary suture", "firstAuthor": "Søndenaa", "multipleAuthors": true, "journal": "J Am Coll Surg", "year": 1995, "design": "rct", "n": 153, "nField": "reported", "population": "patients with chronic pilonidal sinus undergoing surgery", "intervention": "single dose of antibiotic (cefoxitin) given before surgery", "comparator": "no antibiotic prophylaxis", "primaryOutcome": "wound complications, healing within four weeks, and recurrence", "result": "no significant difference in complications, healing time, or recurrence between antibiotic and no-antibiotic groups", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but relatively small and looked at surgical wound healing rather than treating an active infection with antibiotics alone.", "directness": "indirect", "limitations": "studied antibiotic prophylaxis before planned surgery for chronic sinus, not antibiotic treatment of an active cyst or abscess without surgery", "followUp": "six to 30 months", "plainFinding": "No benefit from preventive antibiotic.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/7850048/", "sourceText": "BACKGROUND: Treatment of chronic pilonidal sinus with excision and primary suture is followed by a relatively high proportion of wound infections. The role of preoperative antibiotic prophylaxis in improving results is not clear. STUDY DESIGN: One hundred fifty-three patients with chronic pilonidal sinus were operated on with radical excision and primary suture and randomized to receive a single dose antibiotic prophylaxis of 2 g cefoxitin intravenously (n = 78) or no prophylaxis (n = 75). RESULTS: The most common complications consisted of partial, slight separation of wound edges with slight discharge. In the group with cefoxitin, 34 patients (44 percent) had complications compared with 32 patients (43 percent) in the group without prophylaxis. Fifty-four patients (69 percent) healed within four weeks in the group with cefoxitin, whereas 48 (64 percent) healed within four weeks in the group without prophylaxis. After a follow-up period of six to 30 months, two patients in each group had not healed. Including these, two patients (3 percent) had recurrences in the group with cefoxitin and five patients (7 percent) in the group without prophylaxis (p = 0.41). CONCLUSIONS: The immediate and short-term results after excision and primary suture for chronic pilonidal sinus are not influenced significantly by a single dose prophylaxis of 2 g cefoxitin.", "provenance": [ { "field": "n", "quote": "One hundred fifty-three patients with chronic pilonidal sinus were operated on with radical excision and primary suture and randomized to receive a single dose antibiotic prophylaxis of 2 g cefoxitin intravenously (n = 78) or no prophylaxis (n = 75)." }, { "field": "population", "quote": "One hundred fifty-three patients with chronic pilonidal sinus were operated on with radical excision and primary suture" }, { "field": "intervention", "quote": "a single dose antibiotic prophylaxis of 2 g cefoxitin intravenously" }, { "field": "comparator", "quote": "no prophylaxis" }, { "field": "primaryOutcome", "quote": "Fifty-four patients (69 percent) healed within four weeks in the group with cefoxitin, whereas 48 (64 percent) healed within four weeks in the group without prophylaxis." }, { "field": "result", "quote": "The immediate and short-term results after excision and primary suture for chronic pilonidal sinus are not influenced significantly by a single dose prophylaxis of 2 g cefoxitin." }, { "field": "followUp", "quote": "After a follow-up period of six to 30 months" } ] }, { "id": "pmid:7970033", "pmid": "7970033", "doi": null, "nctId": null, "pmcid": null, "title": "[Pilonidal cysts: the state of the art and the authors' personal experiences]", "firstAuthor": "Palmieri", "multipleAuthors": true, "journal": "Minerva Chir", "year": 1994, "design": "retrospective", "n": 53, "nField": "reported", "population": "patients with pilonidal cyst (35 men, 15 women, average age 23)", "intervention": "one month of antibiotic therapy followed by surgery", "comparator": "none reported — all patients received antibiotics plus surgery", "primaryOutcome": "relapse rate after treatment", "result": "all patients had antibiotics then surgery; 5.7% relapsed between 4 months and 2 years, and relapsed cases were treated again with antibiotics plus surgery and healed with no further relapse after 12 months", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small retrospective case series with no comparison group, so it cannot show whether antibiotics alone did anything — surgery was always performed as well.", "directness": "indirect", "limitations": "Retrospective design, no control group, antibiotics were always combined with surgery so their individual effect cannot be judged, and the study is from 1994 using an older treatment protocol.", "followUp": "at least 12 months", "plainFinding": "Antibiotics only used before surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/7970033/", "sourceText": "After a historical review of the pathogenesis and several therapies suggested for the treatment of pilonidal cysts the authors report the results of a retrospective study performed in the Department of Surgery during a period of four years, with at least 12 months follow-up. This study involved 53 patients (35 males and 15 females, 23 years average age) affected by pilonidal cyst. These patients were treated for a month with antibiotic therapy and underwent surgery by general anaesthesia. Before surgery blue methylene was injected in the cyst. Between 4 months and 2 years 5.7% of operated patients relapsed. After 10 days antibiotic therapy they underwent surgery again by local anaesthesia and then they followed an open treatment protocol including collagen and silver sulfadiazine, healing by delayed wound closure. Furthermore a depilating cream for the border of the wound was suggested to the patient. These patients healed in a period between 4 weeks and 2 months. No relapses were observed after at least 12 months. In our opinion there is the rationale to suggest an open treatment of relapsed pilonidal cyst based on the use of heterologous lyophilized collagen and silver sulfadiazine: it is well accepted by the patient and effective in relapses.", "provenance": [ { "field": "n", "quote": "This study involved 53 patients" }, { "field": "population", "quote": "53 patients (35 males and 15 females, 23 years average age) affected by pilonidal cyst" }, { "field": "intervention", "quote": "These patients were treated for a month with antibiotic therapy and underwent surgery by general anaesthesia" }, { "field": "comparator", "quote": "These patients were treated for a month with antibiotic therapy and underwent surgery by general anaesthesia" }, { "field": "primaryOutcome", "quote": "Between 4 months and 2 years 5.7% of operated patients relapsed" }, { "field": "result", "quote": "Between 4 months and 2 years 5.7% of operated patients relapsed. After 10 days antibiotic therapy they underwent surgery again by local anaesthesia" } ] }, { "id": "pmid:1395879", "pmid": "1395879", "doi": null, "nctId": null, "pmcid": null, "title": "[Treatment of pilonidal sinus with excision and primary suture using a local, resorbable antibiotic carrier. Results of a prospective randomized study]", "firstAuthor": "Vogel", "multipleAuthors": true, "journal": "Chirurg", "year": 1992, "design": "rct", "n": 80, "nField": "reported", "population": "patients having surgery to remove a pilonidal sinus", "intervention": "excision of the sinus with a resorbable collagen sponge containing the antibiotic gentamicin placed in the wound, then stitched closed", "comparator": "excision of the sinus and stitched closed without the antibiotic sponge", "primaryOutcome": "rate of abscess forming at the surgical site afterward", "result": "only 7.5% of patients with the antibiotic sponge developed a postoperative abscess, compared with 52.5% without it", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but small, from one center, and only reported in a brief English abstract so details on how it was conducted are limited.", "directness": "indirect", "limitations": "This studied a local antibiotic sponge used during surgery to prevent abscess formation afterward, not antibiotics used to treat an existing pilonidal cyst or abscess without surgery.", "followUp": "One year after the operation", "plainFinding": "Antibiotic sponge in surgery cut abscess risk", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/1395879/", "sourceText": "The excision of a pilonidal sinus with wound healing by second intention, often results in a long duration of treatment. On the other hand, primary suture after excision has a high rate of abscess formation. In a randomized study we treated 40 patients with excision of pilonidal sinus, insertion of a collagen sponge containing Gentamicin and primary suture (group 1) to prevent this abscess formation. Another 40 patients were treated in the same way but without applying the Gentamicin-collagen sponge (group 2). There had been no significant differences as to the history and duration of the disease, the wound size, the degree of inflammation, the weight of the patients or the amount of hair near the sinus. In group 1 only 7.5% of the patients had a postoperative abscess formation, in contrast to group 2, with an abscess rate of 52.5% and consecutive surgery (p less than 0.001). One year after the operation the recurrence rate was 0 in both groups. Considering the results mentioned, surgical excision of the pilonidal sinus in combination with insertion of a resorbable antibiotic sponge we recommend this therapy.", "provenance": [ { "field": "n", "quote": "we treated 40 patients with excision of pilonidal sinus, insertion of a collagen sponge containing Gentamicin and primary suture (group 1)" }, { "field": "n", "quote": "Another 40 patients were treated in the same way but without applying the Gentamicin-collagen sponge (group 2)." }, { "field": "population", "quote": "we treated 40 patients with excision of pilonidal sinus" }, { "field": "intervention", "quote": "insertion of a collagen sponge containing Gentamicin and primary suture (group 1) to prevent this abscess formation" }, { "field": "comparator", "quote": "treated in the same way but without applying the Gentamicin-collagen sponge (group 2)" }, { "field": "primaryOutcome", "quote": "In group 1 only 7.5% of the patients had a postoperative abscess formation, in contrast to group 2, with an abscess rate of 52.5%" }, { "field": "result", "quote": "In group 1 only 7.5% of the patients had a postoperative abscess formation, in contrast to group 2, with an abscess rate of 52.5% and consecutive surgery (p less than 0.001)." } ] }, { "id": "pmid:2382157", "pmid": "2382157", "doi": "10.1097/00007611-199008000-00017", "nctId": null, "pmcid": null, "title": "Pediatric pilonidal disease: a method of management", "firstAuthor": "Golladay", "multipleAuthors": true, "journal": "South Med J", "year": 1990, "design": "case-series", "n": 11, "nField": "reported", "population": "children with pilonidal disease", "intervention": "aspiration and incision with antibiotics, followed by curettage of the pits", "comparator": "midline surgical procedures", "primaryOutcome": "recurrence of pilonidal disease", "result": "no recurrence after aspiration, incision, antibiotics and curettage; recurrence after midline procedures", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "Tiny, uncontrolled series combining antibiotics with surgery, so it can't show what antibiotics alone do.", "directness": "indirect", "limitations": "Very small numbers, no isolation of antibiotic effect from surgical treatment, retrospective description, pediatric population may differ from typical adult pilonidal disease.", "followUp": "", "plainFinding": "No recurrence with surgery plus antibiotics.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/2382157/", "sourceText": "Pilonidal disease is a common problem; its many management options are testimony to the difficulty in its eradication. Its etiology is distention of midline skin orifices with ingestion of hair shafts from hirsute buttocks. Thus, the disease does not usually appear until after puberty. Nine children were treated by aspiration and incision and antibiotics, followed by curettage of the pits; they had no recurrence. Two children who had midline procedures had recurrent disease. The female-male ratio in children is 4.5:1.", "provenance": [ { "field": "n", "quote": "Nine children were treated by aspiration and incision and antibiotics, followed by curettage of the pits" }, { "field": "n", "quote": "Two children who had midline procedures had recurrent disease." }, { "field": "population", "quote": "Nine children were treated by aspiration and incision and antibiotics" }, { "field": "intervention", "quote": "treated by aspiration and incision and antibiotics, followed by curettage of the pits" }, { "field": "comparator", "quote": "Two children who had midline procedures had recurrent disease." }, { "field": "primaryOutcome", "quote": "they had no recurrence" }, { "field": "result", "quote": "they had no recurrence. Two children who had midline procedures had recurrent disease." } ] }, { "id": "pmid:2683535", "pmid": "2683535", "doi": null, "nctId": null, "pmcid": null, "title": "Bactericidal antimicrobial cover in primary suture of perianal or pilonidal abscess. A prospective, randomized, double-blind clinical trial", "firstAuthor": "Lundhus", "multipleAuthors": true, "journal": "Acta Chir Scand", "year": 1989, "design": "rct", "n": 56, "nField": "reported", "population": "patients having surgery for pilonidal abscess", "intervention": "1-day course of antibiotics (metronidazole and ampicillin) after abscess excision and primary closure", "comparator": "4-day course of the same antibiotics after the same surgery", "primaryOutcome": "wound healing without new sinus or fistula formation", "result": "20 of 26 healed with 1-day treatment versus 20 of 30 with 4-day treatment, a non-significant difference", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "Small number of patients and no comparison to no antibiotics at all, only to a longer antibiotic course, so it can't show whether antibiotics themselves help.", "directness": "indirect", "limitations": "No untreated (no-antibiotic) comparison group; results reported as non-significant without detailed statistics; combines perianal and pilonidal cases.", "followUp": "", "plainFinding": "No benefit from longer antibiotics.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/2683535/", "sourceText": "The effect of 1-day treatment vs. 4-day treatment with metronidazole and ampicillin in association with primary closure of perianal and pilonidal abscesses was evaluated in a double-blind clinical trial. The patients were randomly allocated to 1-day (group I) or 4-day (group II) antibiotic regimen. No clinical signs of sepsis appeared in any patient. Primary healing, without fistula formation was achieved in all 17 perianal abscesses in the 1-day therapy group and in 14 of 15 in the 4-day group (non-significant difference). Excision with primary suture of pilonidal abscess resulted in primary healing in 20 of 26 cases in group I and 20 of 30 in group II (non-significant difference). Healing with formation of a new sinus or secondary healing occurred in four and two cases, respectively, in the 1-day therapy group, and in two and nine of the 4-day group. One-day administration of metronidazole/ampicillin is as effective as 4-day treatment in primary closure of perianal and pilonidal abscess. The procedure appears to be safe in both groups, but more efficacious in perianal abscess.", "provenance": [ { "field": "population", "quote": "Excision with primary suture of pilonidal abscess resulted in primary healing in 20 of 26 cases in group I and 20 of 30 in group II" }, { "field": "intervention", "quote": "1-day (group I)" }, { "field": "comparator", "quote": "4-day (group II) antibiotic regimen" }, { "field": "primaryOutcome", "quote": "Primary healing, without fistula formation" }, { "field": "result", "quote": "Excision with primary suture of pilonidal abscess resulted in primary healing in 20 of 26 cases in group I and 20 of 30 in group II (non-significant difference)." }, { "field": "n", "quote": "20 of 26 cases in group I and 20 of 30 in group II" } ] }, { "id": "pmid:4027539", "pmid": "4027539", "doi": "10.1002/bjs.1800720818", "nctId": null, "pmcid": null, "title": "Pilonidal sinus excision--healing by open granulation", "firstAuthor": "Marks", "multipleAuthors": true, "journal": "Br J Surg", "year": 1985, "design": "prospective-cohort", "n": 100, "nField": "reported", "population": "patients having surgical excision of pilonidal sinus wounds", "intervention": "metronidazole antibiotics (sometimes with erythromycin) given for unhealthy wounds", "comparator": "no antibiotics, or a fixed two-week course of metronidazole, or flexible antibiotic use based on wound appearance", "primaryOutcome": "healing of the excision wound (delays due to infection)", "result": "wounds managed flexibly, with antibiotics only given when they looked unhealthy, healed best", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a small, non-randomised comparison of consecutive groups with no statistics reported, so it can't reliably show whether antibiotics help.", "directness": "indirect", "limitations": "not randomized, groups studied consecutively rather than concurrently, no statistical comparison reported", "followUp": "", "plainFinding": "Selective antibiotics aided healing after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/4027539/", "sourceText": "A prospective study is reported of 100 pilonidal sinus excisions healing by open granulation. Delays in healing appeared to be due to infection, particularly by anaerobic bacteria. Comparisons are made between three groups studied consecutively - 30 wounds not treated with antibiotics, 20 given a fixed two-week course of metronidazole and 50 managed flexibly. In this last group, wound management was determined by clinical appearance; 24 wounds were clinically healthy throughout and received no antibiotic while 26 looked unhealthy initially or after an interval and were treated with metronidazole, supplemented in some cases with erythromycin. The best results were obtained in the group managed flexibly. It is considered that the problems of delayed healing are due to excisions which leave a wound of a shape ill-designed to maintain good drainage. Unhealthy wounds should be re-shaped if possible and treated early with a combination of metronidazole and erythromycin.", "provenance": [ { "field": "n", "quote": "100 pilonidal sinus excisions healing by open granulation" }, { "field": "population", "quote": "100 pilonidal sinus excisions healing by open granulation" }, { "field": "intervention", "quote": "treated with metronidazole, supplemented in some cases with erythromycin" }, { "field": "comparator", "quote": "30 wounds not treated with antibiotics, 20 given a fixed two-week course of metronidazole and 50 managed flexibly" }, { "field": "primaryOutcome", "quote": "Delays in healing appeared to be due to infection, particularly by anaerobic bacteria" }, { "field": "result", "quote": "The best results were obtained in the group managed flexibly" } ] } ], "faqs": [ { "q": "What's the best antibiotic for a pilonidal abscess?", "a": "No study has compared different antibiotics to find a 'best' one for treating an active abscess without surgery. The one study that tracked this used a week of two antibiotics (cefalexin and metronidazole) alongside needle drainage, but it didn't test that combination against any other." }, { "q": "What's the best antibiotic for a pilonidal sinus?", "a": "Studies looking at antibiotics for pilonidal sinus mostly tested them as a one-time dose given around planned surgery, not as a stand-alone treatment for the sinus itself. These trials found mixed or no benefit for preventing infection, so there's no evidence pointing to a 'best' antibiotic for treating a sinus on its own." }, { "q": "How long does it take for a pilonidal cyst to go away with antibiotics?", "a": "There's no reliable timeline, because only one study tracked this and it had no comparison group. In that study, most people who had needle drainage plus about a week of antibiotics were back to normal activity within a day or two, but a cyst treated with antibiotics alone (no drainage) hasn't been studied this way." }, { "q": "Should I stop taking antibiotics for my pilonidal cyst?", "a": "Don't stop anything a clinician has prescribed you without talking to them first. But the evidence doesn't show antibiotics alone reliably clear up an abscess, and in surgical settings, adding antibiotics to the wound was sometimes linked to worse healing. If the area is painful, swollen, or getting worse, the step that's actually been studied is having it drained by a clinician." }, { "q": "Is it safe to try antibiotics before having it drained?", "a": "The studies on this are mixed and mostly look at antibiotics given around surgery rather than instead of it. One trial had to stop early because people who didn't get antibiotics around surgery had very high infection rates, while other trials found no benefit from adding antibiotics. Antibiotics shouldn't be used to delay drainage if an abscess is painful or growing." } ], "searchedAs": [ "pilonidal cyst antibiotics", "best antibiotic for pilonidal cyst", "best antibiotic for pilonidal abscess", "how long does it take for a pilonidal cyst to go away with antibiotics", "best antibiotic for pilonidal sinus", "antibiotic for pilonidal cyst infection", "antibiotics for pilonidal abscess", "antibiotics for pilonidal sinus" ], "patientTakeaway": "Antibiotics by themselves haven't been shown to reliably clear up a pilonidal cyst or abscess — the one study that tested this directly had no comparison group, and two other studies found signs that adding antibiotics can make things worse, not better. If you have a painful lump or abscess, see a clinician for drainage; that's the step with actual evidence behind it. Antibiotics may sometimes be used alongside drainage, but shouldn't be relied on alone or used to put off getting it drained.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "\"Pilonidal Sinus\"[Mesh] AND (\"Anti-Bacterial Agents\"[Mesh] OR antibiotic*[tiab] OR antibacterial*[tiab]) AND (treatment[tiab] OR therapy[tiab] OR management[tiab] OR abscess[tiab] OR drainage[tiab])" }, "pubmedQueryTranslation": "\"Pilonidal Sinus\"[MeSH Terms] AND (\"Anti-Bacterial Agents\"[MeSH Terms] OR \"antibiotic*\"[Title/Abstract] OR \"antibacterial*\"[Title/Abstract]) AND (\"treatment\"[Title/Abstract] OR \"therapy\"[Title/Abstract] OR \"management\"[Title/Abstract] OR \"abscess\"[Title/Abstract] OR \"drainage\"[Title/Abstract])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Do antibiotics clear a pilonidal cyst or abscess?", "description": "Only 1 small study tested antibiotics alone for pilonidal abscess; 2 trials found signs of harm. Here's what the research actually shows." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }