From the Guidelines
Nasal abscess treatment should always involve incision and drainage, followed by empiric antibiotic therapy, due to the high risk of complications and the potential for severe morbidity and mortality. The primary treatment is incision and drainage of the abscess by a healthcare provider, which allows for removal of the purulent material and collection of samples for culture 1. Following drainage, empiric antibiotic therapy should be initiated, commonly with antibiotics that cover Staphylococcus aureus and streptococci.
Key Considerations
- Appropriate options include amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days), clindamycin (300-450 mg four times daily for 7-10 days), or trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily for 7-10 days) if MRSA is suspected 1.
- The antibiotic regimen may be adjusted based on culture results.
- Warm compresses applied to the area several times daily can help improve blood circulation and promote healing.
- Pain management with acetaminophen or ibuprofen is often necessary.
- Patients should complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence and complications.
Rationale
Nasal abscesses require thorough treatment because of their proximity to critical structures like the cavernous sinus, which could lead to serious complications including cavernous sinus thrombosis or intracranial infections if inadequately treated. The guidelines from the Infectious Diseases Society of America recommend incision and drainage as the primary treatment for cutaneous abscesses, including nasal abscesses, with antibiotic therapy recommended for abscesses associated with severe or extensive disease, rapid progression, or signs of systemic illness 1.
From the Research
Nasal Abscess Treatment Overview
- Nasal septal abscesses are uncommon but can cause potentially life-threatening intracranial complications and cosmetic nasal deformity 2.
- The most common symptoms at presentation are nasal pain and nasal obstruction, with typical etiologies being trauma or acute sinusitis, as well as uncontrolled diabetes mellitus 2.
- Immunocompromised patients are also at risk of developing nasal septal abscesses without a history of nasal trauma 3.
Treatment Approaches
- Prompt diagnosis, adequate surgical drainage, and antibiotics are necessary to prevent the spread of infection and severe functional and cosmetic sequelae 3, 4.
- Parenteral broad-spectrum antibiotics, appropriate drainage, and immediate reconstruction of the destructed septal cartilage with autologous cartilage graft are recommended to prevent serious intracranial complications and cosmetic nasal deformity 2.
- Amoxicillin/clavulanate (Augmentin) is a broad-spectrum antibacterial that can be used in the treatment of community-acquired respiratory tract infections, including those caused by beta-lactamase-producing pathogens 5.
Management Strategies
- Diagnostic needle aspiration, antibiotic coverage, and surgical drainage are essential components of nasal septal abscess management 4.
- Ultrasound can be valuable in diagnosing abscesses and guiding incision and drainage (I&D) procedures, although packing may be unnecessary for small abscesses 6.
- Antibiotics, needle aspiration, and loop drainage are suitable alternatives to I&D for abscesses with certain characteristics, and oral antibiotics can improve outcomes after I&D 6.