From the Guidelines
The treatment for a purulent abscess in a pregnant patient primarily involves incision and drainage (I&D), which is considered the definitive management regardless of pregnancy status. This procedure should be performed promptly to prevent complications and is generally safe during pregnancy, as supported by the guidelines from the Infectious Diseases Society of America 1. Local anesthesia with lidocaine (typically 1% solution) can be used safely. Following drainage, wound packing with sterile gauze may be necessary for larger abscesses, with dressing changes every 24-48 hours until healing occurs.
Key Considerations
- Antibiotics are often prescribed as adjunctive therapy, with safe options during pregnancy including penicillins (such as amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days), cephalosporins (like cephalexin 500 mg four times daily for 5-7 days), or clindamycin (300-450 mg four times daily for 5-7 days) for penicillin-allergic patients, as recommended by 1 and 1.
- Methicillin-resistant Staphylococcus aureus (MRSA) coverage may be necessary depending on local prevalence, with trimethoprim-sulfamethoxazole generally avoided in the first trimester and near term, as noted in 1 and 1.
- Pain management can include acetaminophen (up to 1000 mg every 6 hours), and warm compresses may provide additional relief.
- Surgical consultation is recommended for complex, recurrent, or facial abscesses, emphasizing the importance of individualized care based on the patient's condition and response to initial treatment, as suggested by 1 and 1.
Antibiotic Selection
The selection of antibiotics should consider both antimicrobial efficacy and pregnancy safety profiles. Given the potential risks and benefits, clindamycin is a preferred option for pregnant patients with purulent abscesses, especially when MRSA coverage is necessary, as indicated by 1 and 1. However, the final decision should be made based on the most recent and highest quality evidence available, taking into account local resistance patterns and the specific clinical scenario, as emphasized by 1 and 1.
From the Research
Treatment Options for Purulent Abscess in Pregnant Patients
- Incision and drainage is a common treatment for simple abscesses, and wound culture and antibiotics may not be necessary for healing 2
- For pregnant patients, noninvasive diagnostic techniques such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) can be used to diagnose pelvic or abdominal abscesses 3
- Imaging-guided, percutaneous transcatheter drainage may be a suitable treatment option for pregnant patients with intraabdominal abscesses 3
- Antibiotic treatment alone can be effective for abscesses of different sizes and locations, but the penetration of antibiotics into the abscess is limited and dependent on the degree of abscess maturation 4
- Minimally invasive treatment options, such as sonographically assisted abscess drainage and antibiotics, may be suitable for pregnant patients with psoas abscesses 5
Considerations for Abscess Management in Pregnant Patients
- The choice of treatment should take into account the size and location of the abscess, as well as the patient's symptoms and overall health 2, 3, 4, 5
- Ultrasound can be a valuable tool in diagnosing and guiding the treatment of abscesses in pregnant patients 3, 5, 6
- The use of antibiotics should be carefully considered, as they may not always be necessary or effective in treating abscesses 2, 4, 6
- The treatment of abscesses in pregnant patients should be individualized and take into account the unique needs and circumstances of each patient 3, 5, 6