From the Guidelines
Not all patients with an abscess require antibiotic therapy, and the primary treatment for most simple abscesses is incision and drainage (I&D) alone. The decision to add antibiotics to I&D should be based on specific clinical scenarios, such as the presence of systemic symptoms (fever, tachycardia), surrounding cellulitis extending more than 5 cm beyond the abscess, immunocompromised status, extremes of age (very young or elderly), abscesses in sensitive areas (face, hands, genitals), or when adequate drainage cannot be achieved 1.
When antibiotics are indicated, options include trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 DS tablets twice daily, doxycycline 100 mg twice daily, or clindamycin 300-450 mg four times daily, typically for 5-10 days, as these provide coverage against methicillin-resistant Staphylococcus aureus (MRSA), a common cause of skin abscesses 1.
Key considerations for the management of abscesses include:
- Incision and drainage as the primary treatment for simple abscesses
- Addition of antibiotics in specific clinical scenarios
- Choice of antibiotics based on coverage of likely pathogens, including MRSA
- Duration of antibiotic therapy typically ranging from 5 to 10 days
- Importance of proper wound care after drainage, including keeping the area clean and applying warm compresses, regardless of whether antibiotics are prescribed 1.
The rationale for limiting antibiotic use in simple, well-drained abscesses is to prevent antibiotic resistance, reduce side effects, and minimize healthcare costs while still achieving good clinical outcomes 1.
From the Research
Treatment of Abscesses
The question of whether all patients with an abscess should start antibiotic therapy is complex and depends on various factors.
- Incision and Drainage: Studies have shown that incision and drainage alone can be effective in treating abscesses, with cure rates of at least 90% 2.
- Use of Antibiotics: The use of antibiotics is not always necessary and should be considered on a case-by-case basis. For example, if incision and drainage fail to promote healing within 7 days, oral antibiotics such as trimethoprim-sulfamethoxazole and tetracycline may be considered 2.
- Type of Abscess: The type of abscess and the causative organism can also influence the decision to use antibiotics. For example, community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) abscesses may require different treatment approaches 3, 4.
- Systemic Antibiotics: A meta-analysis found that systemic antibiotics did not significantly improve the percentage of patients with complete resolution of their abscesses 7-10 days after treatment, when given in addition to incision and drainage 5.
Specific Considerations
- MRSA Abscesses: For MRSA abscesses, minocycline may be a reliable option when other antibiotics such as doxycycline or trimethoprim-sulfamethoxazole fail 3.
- Abdominal Abscesses: For abdominal abscesses, prompt drainage and properly selected antibiotics at adequate doses are essential for optimal treatment 6.
- Wound Cultures: Wound cultures are generally not necessary in the emergency department, and antibiotics and decolonization should be used selectively, not routinely, for treatment of most uncomplicated abscesses 4.