What is the management of a 5-centimeter abscess (abscess) located at the left lower extremity in a non-diabetic patient?

From the Guidelines

Management of a 5 cm abscess on the left lower extremity in a non-diabetic patient primarily requires incision and drainage (I&D) as the definitive treatment, with empiric antibiotic therapy recommended due to the large size of the abscess. The procedure should be performed under appropriate local anesthesia, creating an adequate incision to allow complete drainage of purulent material. After drainage, the cavity should be explored to break up loculations, followed by irrigation with sterile saline. The wound should generally be left open with loose packing to allow continued drainage, with daily dressing changes until the wound shows healthy granulation tissue.

• Empiric antibiotic therapy with medications like trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 DS tablets twice daily, clindamycin 300-450 mg four times daily, or doxycycline 100 mg twice daily for 5-10 days is recommended, especially given the large size (≥5 cm) of the abscess which increases risk of systemic infection 1.
• Wound cultures should be obtained during the procedure to guide targeted antibiotic therapy if the patient fails to improve.
• Pain management with acetaminophen or NSAIDs is appropriate, and the patient should be instructed to elevate the affected limb to reduce swelling.
• Close follow-up within 24-48 hours is essential to assess healing progress. This approach combines mechanical removal of the infectious focus through drainage with antimicrobial therapy to address any surrounding cellulitis or systemic spread, which is particularly important for larger abscesses. The choice of antibiotic should be guided by knowledge of local patterns of susceptibility of S. aureus, especially local rates of MRSA, as noted in the guidelines for managing skin abscesses 1.

From the Research

Management of 5 cm Abscess at Left Lower Extremity in Non-Diabetic Patient

• The management of a 5 cm abscess at the left lower extremity in a non-diabetic patient typically involves incision and drainage (I&D) 2, 3, 4.
• According to a study published in 2022, most simple abscesses can be diagnosed upon clinical examination and safely managed in the ambulatory office with I&D 2.
• Wound culture and antibiotics do not improve healing, but packing wounds larger than 5 cm may reduce recurrence and complications 2.
• A study published in 1985 notes that treatment consists of surgical drainage with the addition of antibiotics in selected cases, and postoperative care includes warm soaks, drains or wicks, analgesia, and close follow-up 3.
• Another study published in 2022 suggests that loop drainage is preferred over the traditional incision and drainage technique, and adjunctive antibiotics can be considered 4.
• Systemic antibiotics after incision and drainage of simple abscesses do not significantly improve cure rates, according to a meta-analysis published in 2014 5.
• A review published in 2016 found that wound packing and post-procedural antibiotics may not be beneficial in the treatment of uncomplicated abscesses, and that I&D alone may be sufficient as the sole management 6.

Considerations for Treatment

• The size of the abscess (5 cm) may require packing to reduce recurrence and complications 2.
• The location of the abscess (left lower extremity) may require special consideration for diagnosis and treatment, and may involve different infectious agents 3.
• The patient's non-diabetic status may reduce the risk of complications, but it is still important to monitor for signs of infection and to provide proper wound care 4.
• The use of antibiotics should be considered on a case-by-case basis, taking into account the patient's individual risk factors and the presence of high-risk features 6.