What is the first-line treatment for an abscess in a non-diabetic person?

First-Line Treatment for Abscesses in Non-Diabetic Individuals

Incision and drainage is the primary treatment for simple abscesses or boils in non-diabetic individuals, and antibiotics are not recommended for simple abscesses. 1

Diagnosis and Assessment

• Abscesses present as well-circumscribed collections of purulent material with surrounding inflammation and induration 1, 2
• Physical examination typically reveals erythema, tenderness, and induration 1
• The majority of superficial skin and soft tissue infections (SSTIs) are caused by Gram-positive bacteria, particularly Staphylococcus aureus 1
• Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly common in community-acquired abscesses 3, 4

Treatment Algorithm

Simple Abscesses

• Primary treatment: Incision and drainage alone 1, 2, 3
  • No antibiotics are needed for simple, uncomplicated abscesses 1, 3
  • Evidence shows high cure rates (90.5%) with incision and drainage alone, even for MRSA infections 3
  • Packing of the wound is optional and may be omitted without affecting outcomes for abscesses smaller than 5 cm 5

Complex Abscesses

• Complex abscesses require incision and drainage plus antibiotics if: 1

  • Systemic signs of infection are present
  • Patient is immunocompromised
  • Source control is incomplete
  • Significant surrounding cellulitis is present

• For complex abscesses requiring antibiotics, use empiric broad-spectrum coverage against: 1

  • Gram-positive bacteria (especially S. aureus)
  • Gram-negative bacteria
  • Anaerobic bacteria

Antibiotic Selection (When Indicated)

• For mild to moderate infections requiring antibiotics:

  • Clindamycin 150-300 mg orally every 6 hours 6
  • Trimethoprim-sulfamethoxazole (if MRSA is suspected) 7, 8

• For severe infections requiring antibiotics:

  • Clindamycin 300-450 mg orally every 6 hours 6
  • Consider parenteral therapy for systemic symptoms 9

Important Considerations and Caveats

• Antibiotics alone do not improve healing of properly drained simple abscesses 2, 3
• Empiric therapy for community-acquired MRSA should be considered for patients at risk for CA-MRSA or who do not respond to first-line therapy 1
• Diabetic patients have different microbial patterns and may require different antibiotic strategies 8
• Perianal and perirectal abscesses are considered complex and often require both drainage and antibiotics 1
• For abdominal abscesses, percutaneous drainage combined with antibiotics is generally recommended 1
• Patients with ongoing signs of infection beyond expected resolution time warrant further diagnostic investigation 1

Follow-up

• Clinical improvement should be seen within 3-5 days after incision and drainage 1
• If a patient's condition does not improve, re-evaluation and repeat imaging may be indicated 1
• For recurrent abscesses, consider underlying conditions or inadequate initial drainage 1