Treatment of Uncomplicated Abscesses
For simple, uncomplicated abscesses, incision and drainage alone is the primary treatment, and antibiotics are unnecessary. 1
Primary Management Approach
- Incision and drainage is the cornerstone of treatment for uncomplicated abscesses and should be performed promptly 1
- For simple abscesses with minimal surrounding erythema (<5 cm) and no systemic signs, antibiotics are not needed after adequate drainage 1, 2
- To be considered a simple abscess, induration and erythema should be limited only to a defined area of the abscess and should not extend beyond its borders 2
- Simple abscesses do not extend into deeper tissues or have multiloculated extension 2
When Antibiotics Are Indicated
Antibiotics should be added to incision and drainage in the following scenarios:
- Presence of systemic signs of infection (temperature >38.5°C, heart rate >110 beats/minute) 1
- Erythema extending >5 cm beyond wound margins 1
- Immunocompromised patients 1
- Incomplete source control after drainage 1
- Significant surrounding cellulitis 2, 1
Antibiotic Selection When Indicated
When antibiotics are necessary, the following options are recommended:
- Trimethoprim-sulfamethoxazole (TMP-SMX) is effective for uncomplicated abscesses requiring antibiotics, especially in areas with high MRSA prevalence 3, 4
- Clindamycin is an alternative option with similar cure rates to TMP-SMX but with more frequent adverse events 3
- For 7-10 days when antibiotics are indicated 1, 3
Evidence Supporting Antibiotic Use in Specific Situations
- A 2017 randomized controlled trial showed that compared with incision and drainage alone, adding TMP-SMX or clindamycin improved short-term outcomes in patients with smaller abscesses (≤5 cm) 3
- TMP-SMX resulted in higher cure rates (80.5% vs. 73.6% in placebo) and lower rates of subsequent surgical drainage procedures in settings where MRSA was prevalent 4
- Clindamycin was associated with fewer new infections at 1-month follow-up compared to TMP-SMX (6.8% vs. 13.5%) 3
Common Pitfalls to Avoid
- Overuse of antibiotics for simple abscesses that only require incision and drainage 5
- Failing to recognize when antibiotics are truly indicated (systemic signs, extensive cellulitis, immunocompromised state) 1
- Not considering local MRSA prevalence when selecting empiric antibiotics when they are indicated 4
- Inadequate drainage, which is the most important aspect of treatment 2, 1