From the Guidelines
Finger abscesses should be treated promptly with incision and drainage (I&D) as the primary treatment, and antibiotics may be considered in certain cases, such as severe or extensive disease, signs of systemic illness, or lack of response to I&D alone, as recommended by the Infectious Diseases Society of America 1.
Treatment Approach
The treatment of finger abscesses involves a combination of surgical and medical approaches.
- Incision and drainage (I&D) is the primary treatment for finger abscesses, as it allows for the release of pus and reduction of pressure in the affected area.
- Antibiotic therapy may be considered in addition to I&D in certain cases, such as:
- Severe or extensive disease
- Signs of systemic illness
- Lack of response to I&D alone
- Abscess in an area difficult to drain, such as the face, hand, or genitalia
Antibiotic Options
For empirical coverage of CA-MRSA in outpatients with SSTI, oral antibiotic options include:
- Clindamycin (A-II)
- Trimethoprim-sulfamethoxazole (TMP-SMX) (A-II)
- A tetracycline (doxycycline or minocycline) (A-II)
- Linezolid (A-II) If coverage for both b-hemolytic streptococci and CA-MRSA is desired, options include:
- Clindamycin alone (A-II)
- TMP-SMX or a tetracycline in combination with a b-lactam (eg, amoxicillin) (A-II)
- Linezolid alone (A-II)
Post-Treatment Care
After treatment, warm water soaks for 15 minutes 3-4 times daily can help promote healing. Pain management with acetaminophen or ibuprofen is usually sufficient. Patients should seek immediate medical attention if they develop fever, red streaking up the arm, or worsening pain despite treatment, as these may be signs of a more serious infection or complication 1.
From the Research
Finger Abscess Treatment
- The primary treatment for finger abscesses is incision and drainage, which can be safely managed in an ambulatory office setting 2.
- Wound culture and antibiotics do not typically improve healing, but packing wounds larger than 5 cm may reduce recurrence and complications 2.
- Systemic antibiotics do not significantly improve the percentage of patients with complete resolution of their abscesses when given in addition to incision and drainage 3.
Management of Abscesses
- Loop drainage is preferred over traditional incision and drainage technique, and adjunctive antibiotics can be considered 4.
- Most patients with abscesses can be managed as outpatients 4.
- Ultrasound is valuable in diagnosing abscesses that are not clinically evident and in guiding incision and drainage procedures 5.
- Although incision and drainage is traditionally followed by packing, this practice may be unnecessary for small abscesses 5.
Treatment Strategies
- There is variability in treatment strategies for abscess care, with most providers using narcotic analgesics, linear incisions, and packing 6.
- Most providers do not irrigate, order wound cultures, or routinely prescribe oral antibiotics unless specific risk factors or physical signs are present 6.
- Antibiotic treatment, if used, often favors a combination of 2 or more drugs to cover both Streptococcus and methicillin-resistant Staphylococcus aureus 6.