From the Guidelines
Treatment for a skin abscess typically involves incision and drainage (I&D) as the primary intervention, with antibiotics recommended in addition to I&D for larger abscesses, those with surrounding cellulitis, or in patients with fever or other systemic symptoms. This procedure entails making a small cut in the abscess to allow the pus to drain out, which relieves pressure and promotes healing 1. For small abscesses (less than 5 cm), I&D alone is often sufficient without antibiotics. After drainage, the wound should be packed with sterile gauze and changed daily until it heals from the inside out.
Key Considerations
- Antibiotic therapy is recommended for abscesses associated with severe or extensive disease, rapid progression, signs and symptoms of systemic illness, associated comorbidities or immunosuppression, extremes of age, abscess in an area difficult to drain, associated septic phlebitis, or lack of response to I&D alone 1.
- Common antibiotic choices include trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily for 7-10 days, or doxycycline 100 mg twice daily for 7-10 days, as these cover MRSA which commonly causes skin abscesses 1.
- Warm compresses applied to the area for 15 minutes several times daily can help draw the infection to the surface and promote drainage.
- Pain management with acetaminophen or ibuprofen is often helpful.
- Patients should seek immediate medical attention if they develop fever, increasing redness or swelling, or if the abscess doesn't improve within 48 hours of treatment.
Antibiotic Options
- For empirical coverage of CA-MRSA in outpatients with SSTI, oral antibiotic options include clindamycin, TMP-SMX, a tetracycline (doxycycline or minocycline), and linezolid 1.
- If coverage for both b-hemolytic streptococci and CA-MRSA is desired, options include clindamycin alone, or TMP-SMX or a tetracycline in combination with a b-lactam (eg, amoxicillin), or linezolid alone 1.
From the FDA Drug Label
The cure rates in clinically evaluable patients were 90% in linezolid-treated patients and 85% in oxacillin-treated patients A separate study provided additional experience with the use of ZYVOX in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. The cure rates in microbiologically evaluable patients with MRSA skin and skin structure infection were 26/33 (79%) for linezolid-treated patients and 24/33 (73%) for vancomycin-treated patients Treatment for skin abscess can include linezolid, with cure rates of:
- 90% in clinically evaluable patients with complicated skin and skin structure infections
- 79% in microbiologically evaluable patients with MRSA skin and skin structure infection 2
From the Research
Treatment Options for Skin Abscess
- Incision and drainage (I&D) is the standard of care for skin abscesses, with significant variability in post-procedural treatment 3
- Wound packing after I&D may not be beneficial, with studies showing no difference in treatment failure rates or recurrence rates, but increased pain in packed wounds 3
- The use of post-procedural antibiotics is also debated, with some studies showing no decrease in treatment failure rates, but potential short-term benefits in reducing new lesion formation 3, 4
Antibiotic Use in Skin Abscess Treatment
- Antibiotics may be considered in high-risk cases, such as immunocompromised patients or those with positive wound cultures for MRSA 3, 5
- Commonly prescribed antibiotics for skin abscesses include trimethoprim-sulfamethoxazole, cephalexin, and clindamycin, with doxycycline and trimethoprim-sulfamethoxazole being effective against MRSA 6, 5
- However, antibiotic overuse is a concern, with studies showing high rates of antibiotic prescription for uncomplicated skin abscesses, despite limited evidence of benefit 6, 4