What is the best treatment for an abscess?

From the Guidelines

The best treatment for a pilonidal abscess, such as the one described, typically involves incision and drainage (I&D) performed by a healthcare provider, as well as the use of antibiotics in certain cases, especially if there are signs of systemic illness, severe disease, or if the patient is immunocompromised 1. Given the patient's history of a similar abscess 6-7 months ago and the current abscess having opened on its own, it is crucial to manage the condition effectively to prevent recurrence and potential complications. The patient should be advised to:

• Keep the wound clean and covered with sterile dressings that should be changed regularly.
• Apply warm compresses to the area to help promote healing and reduce discomfort.
• Consider taking pain relievers such as ibuprofen (400-600 mg every 6 hours) or acetaminophen (500-1000 mg every 6 hours) to manage pain.
• Be aware of the signs of infection or worsening condition, such as increased redness, swelling, or fever, and seek medical attention if these occur. It is also important to note that the use of antibiotics may be recommended in certain cases, such as when there are signs of systemic illness or severe disease, and the choice of antibiotic should be based on the severity of the infection and the patient's underlying health conditions, with options including trimethoprim-sulfamethoxazole, clindamycin, or doxycycline 1. However, the most recent and highest quality study 1 suggests that incision and drainage is the primary treatment for anorectal abscesses, and the timing of surgery should be based on the presence and severity of sepsis. Therefore, the patient should be referred to a healthcare provider for further evaluation and management, including possible incision and drainage, and antibiotic therapy if necessary.

From the FDA Drug Label

INDICATIONS AND USAGE Cephalexin is indicated for the treatment of the following infections when caused by susceptible strains of the designated microorganisms: ... Skin and skin structure infections caused by Staphylococcus aureus and/or Streptococcus pyogenes

The best treatment for an abscess, specifically a pilonidal abscess, is not directly stated in the provided drug labels. However, cephalexin is indicated for the treatment of skin and skin structure infections caused by susceptible strains of microorganisms.

• Key points:
  • Cephalexin may be used to treat skin and skin structure infections.
  • The drug labels do not specifically address the treatment of pilonidal abscesses.
  • Warm compresses, as mentioned, are a common initial treatment for abscesses to help bring the infection to a head and encourage drainage. Given the information provided and the fact that the abscess has opened on its own, caution should be exercised, and it is recommended to consult a healthcare professional for proper evaluation and treatment. 2 2

From the Research

Abscess Treatment Overview

• An abscess is a localized collection of purulent material surrounded by inflammation and granulation in response to an infectious source 3
• Most simple abscesses can be diagnosed upon clinical examination and safely managed in the ambulatory office with incision and drainage 3

Incision and Drainage

• Incision and drainage (I&D) is the standard of care for abscesses, and wound culture and antibiotics do not improve healing 3
• Packing wounds larger than 5 cm may reduce recurrence and complications 3
• I&D is traditionally followed by packing, but this practice may be unnecessary for small abscesses 4

Antibiotics

• Systemic antibiotics do not significantly improve the percentage of patients with complete resolution of their abscesses when given in addition to incision and drainage 5
• Antibiotics should be considered in the presence of high-risk features, but routine use of post-procedural antibiotics is not recommended 6
• Oral antibiotics can improve outcomes after I&D, although this improvement must be weighed against potential risks 4

Pilonidal Abscesses

• Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative 4
• Recent research has evaluated the use of ultrasonography, packing, incision and drainage (I&D), and antibiotics in the management of pilonidal abscesses 4

Management Strategies

• Ultrasound is valuable in diagnosing abscesses that are not clinically evident and in guiding I&D procedures 4
• Needle aspiration and loop drainage are suitable alternatives to I&D of abscesses with certain characteristics 4
• Many strategies are useful in managing specific types of abscesses, such as Bartholin, breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses 4