What is the recommended treatment for draining a facial abscess?

Management of Facial Abscesses

The primary treatment for a facial abscess is incision and drainage, which should be performed without the need for irrigation with any specific cleaning solution. 1

Initial Management

• Incision and drainage is the cornerstone of treatment for facial abscesses and should be performed promptly 1
• Simply covering the surgical site with a dry dressing after drainage is usually the most effective wound management 1
• Cultures of the abscess material should be obtained during drainage to guide antibiotic therapy if needed 1
• Packing the wound with gauze is not necessary and may cause more pain without improving healing 1

When to Add Antibiotics

Antibiotics should be added to incision and drainage in the following situations:

• Presence of systemic inflammatory response syndrome (SIRS): temperature >38°C or <36°C, tachypnea >24 breaths/min, tachycardia >90 beats/min, or abnormal white blood cell count 1
• Severe or extensive disease involving multiple sites 1
• Rapid progression with associated cellulitis 1
• Immunocompromised patients 1
• Abscesses in the face (as this is considered a difficult-to-drain area) 1
• Incomplete source control after drainage 1

Antibiotic Selection

When antibiotics are indicated for facial abscesses:

• For empiric coverage of MRSA (which is increasingly common in community settings), options include: 1

  • Clindamycin: 300-450 mg PO three times daily 1
  • Trimethoprim-sulfamethoxazole (TMP-SMX): 1-2 double-strength tablets twice daily 1
  • Doxycycline: 100 mg PO twice daily (not for children under 8 years) 1
  • Linezolid: 600 mg PO twice daily (more expensive option) 1

• For more severe infections requiring intravenous therapy: 1

  • Vancomycin: 15-20 mg/kg IV every 8-12 hours 1
  • Clindamycin: 600-900 mg IV every 8 hours 1
  • Linezolid: 600 mg IV twice daily 1
  • Daptomycin: 4 mg/kg IV daily 1

Duration of Therapy

• For most uncomplicated facial abscesses treated with antibiotics, a 5-10 day course is recommended 1
• Treatment should be extended if the infection has not improved within this time period 1

Special Considerations

• For recurrent abscesses, consider a 5-day decolonization regimen with intranasal mupirocin, daily chlorhexidine washes, and daily decontamination of personal items 1
• Recent evidence suggests that even for smaller abscesses, adding antibiotics (clindamycin or TMP-SMX) to incision and drainage improves short-term outcomes, particularly for Staphylococcus aureus infections 2
• However, for simple, uncomplicated abscesses, several studies show high cure rates (85-90%) with incision and drainage alone 1, 3, 4

Pediatric Considerations

• For children with facial abscesses, vancomycin is recommended for hospitalized cases 1
• If the patient is stable without ongoing bacteremia, clindamycin 10-13 mg/kg/dose IV every 6-8 hours is an option if local clindamycin resistance rates are low 1
• Tetracyclines should not be used in children under 8 years of age 1

Remember that facial abscesses require prompt treatment due to their location and potential for complications. Proper incision and drainage technique is essential, with antibiotics added based on the specific clinical scenario.