Treatment of Uncomplicated Abscess
For an uncomplicated abscess, incision and drainage is the primary treatment. 1 This surgical approach remains the cornerstone of management for all abscesses, as it directly addresses the collection of purulent material.
Surgical Management
Incision and Drainage Procedure
- Make the incision as close as possible to the abscess site while ensuring adequate drainage
- Ensure complete drainage of the abscess to minimize recurrence risk
- For abscesses ≤5 cm in diameter, incision and drainage alone is typically sufficient 1, 2
- For simple abscesses or boils, additional antibiotics may not be necessary 1
Post-Drainage Care
- Simply covering the surgical site with a dry dressing is usually effective 3
- Warm soaks can be used to promote continued drainage 3
- For larger wounds (>5 cm), packing may reduce recurrence and complications 2
- Close follow-up within 48-72 hours is recommended to assess healing progress 3
Antibiotic Therapy
When to Add Antibiotics
Antibiotics should be added to incision and drainage in the following situations 1:
- Severe or extensive disease (multiple infection sites)
- Rapid progression with associated cellulitis
- Signs and symptoms of systemic illness
- Associated comorbidities or immunosuppression
- Extremes of age
- Abscess in difficult-to-drain areas (face, hand, genitalia)
- Associated septic phlebitis
- Lack of response to incision and drainage alone
Antibiotic Options for Outpatients
If antibiotics are indicated, recommended options include 1:
- Clindamycin
- Trimethoprim-sulfamethoxazole (TMP-SMX)
- Tetracyclines (doxycycline or minocycline)
- Linezolid
Duration of Antibiotic Therapy
- 5-10 days of therapy is typically recommended, but should be individualized based on clinical response 1
- Recent evidence suggests shorter courses (<5 days) may be sufficient following adequate drainage 4
Special Considerations
Anorectal Abscesses
- Surgical drainage remains the treatment of choice 1
- Timing of surgery should be based on presence and severity of sepsis 1
- Small perianal abscesses in immunocompetent patients without systemic signs may be managed as outpatients 1
Dental Abscesses
- Require drainage through endodontic treatment or extraction of the affected tooth 3
- Appropriate antibiotic therapy based on severity and extent of infection 3
Evidence on Antibiotics vs. Drainage Alone
Recent research has shown that for smaller abscesses (≤5 cm), the addition of antibiotics (clindamycin or TMP-SMX) to incision and drainage improves short-term outcomes compared to incision and drainage alone 5. However, this benefit must be weighed against potential side effects of antimicrobial therapy.
Common Pitfalls to Avoid
- Inadequate drainage leading to recurrence
- Premature closure of the drainage site
- Unnecessary antibiotic use for simple abscesses after adequate drainage
- Failure to obtain wound cultures when antibiotics are indicated
- Inappropriate antibiotic selection when treatment is necessary
- Missing underlying conditions that may predispose to abscess formation
In summary, while incision and drainage remains the definitive treatment for uncomplicated abscesses, the decision to add antibiotics should be based on specific clinical factors and patient characteristics.