From the Guidelines
The best treatment approach for a small gluteal abscess is incision and drainage (I&D), which should be performed as soon as possible. This procedure involves making a small incision over the abscess, evacuating the purulent material, breaking up any loculations, and leaving the wound open to heal by secondary intention. Local anesthesia with 1% lidocaine (avoiding epinephrine) is typically sufficient for small abscesses. After drainage, the wound should be packed lightly with sterile gauze and changed daily until the wound begins to heal.
Key Considerations
- Antibiotics are generally not required for simple, small abscesses after adequate drainage unless the patient has systemic symptoms (fever, elevated white blood cell count), surrounding cellulitis, immunocompromise, or is at risk for endocarditis.
- When antibiotics are needed, options include trimethoprim-sulfamethoxazole (one double-strength tablet twice daily), doxycycline (100mg twice daily), or clindamycin (300-450mg four times daily) for 5-7 days to cover MRSA, as recommended by the Infectious Diseases Society of America 1.
- Warm compresses applied to the area several times daily can help with healing and pain relief.
- Incision and drainage is the definitive treatment because abscesses represent a walled-off collection of pus that antibiotics alone cannot adequately penetrate, making mechanical drainage necessary for resolution.
Recent Guidelines
Recent guidelines from the World Journal of Emergency Surgery (2018) also support incision and drainage as the primary treatment for skin and soft-tissue infections, including abscesses, with antibiotic therapy reserved for cases with systemic signs of infection, immunocompromised patients, or incomplete source control 1.
From the Research
Treatment Approaches for Small Gluteal Abscess
- The treatment for a small gluteal abscess can vary depending on the underlying cause and severity of the abscess.
- In some cases, incision and drainage may be necessary, as seen in a study where a patient with a gluteal abscess due to Crohn's disease underwent surgical incision and drainage, resulting in resolution of pain and fever 2.
- The use of systemic antibiotics after incision and drainage is still a topic of debate, with some studies suggesting that they may not be necessary for simple abscesses 3.
- However, in cases where the abscess is caused by a specific infection, such as tuberculosis, antitubercular treatment may be necessary, as seen in a case report of a 3-year-old girl with a gluteal abscess due to Pott's spine 4.
Considerations for Treatment
- The treatment approach should take into account the location and severity of the abscess, as well as the patient's overall health and medical history.
- In general, superficial abscesses can be treated with incision and drainage, and antibiotics may not be necessary unless there are signs of systemic infection or the patient is at high risk of complications 5.
- In the era of increased community-associated methicillin-resistant Staphylococcus aureus (MRSA), it is essential to consider the possibility of MRSA infection when treating abscesses, and to use antibiotics and decolonization strategies judiciously 6.