Should pus be expressed from an infected cut with an abscess in a child treated with Bactroban 2% (mupirocin), and what is the appropriate wound care?

Management of Small Infected Leg Wound with Abscess in a 9-Year-Old

Yes, you should drain the pus from the abscess—incision and drainage is the primary treatment for any cutaneous abscess, and antibiotics like Bactroban play only a supportive role. 1

Immediate Management: Drainage is Essential

• The most important therapy for a simple superficial abscess is incision and drainage, which is the primary treatment, and antibiotics are often unnecessary for simple abscesses 1
• For a simple abscess to be managed with drainage alone, the induration and erythema should be limited only to the defined area of the abscess and should not extend beyond its borders 1
• Gently express the pus by applying pressure around the abscess after making a small incision if needed, or if it's already pointing and ready to drain spontaneously 1
• Incision and drainage of superficial abscesses rarely causes bacteremia, so prophylactic antibiotics beyond topical therapy are not routinely needed 1

When to Add Systemic Antibiotics

You should consider adding oral antibiotics if any of the following are present:

• Surrounding cellulitis extending >5 cm beyond the wound margins 1
• Systemic signs: temperature >38.5°C, heart rate >110 beats/minute, or white blood cell count >12,000 cells/µL 1
• Significant surrounding soft tissue infection or induration 1
• The child is immunocompromised or has other risk factors 1

If systemic antibiotics are needed, a short course of 24-48 hours may be sufficient if drainage is adequate 1

Role of Bactroban (Mupirocin 2%)

• Continue the Bactroban 2% ointment applied 2-3 times daily—it has excellent efficacy against staphylococci and streptococci, the predominant pathogens in superficial skin infections 2, 3
• Mupirocin is highly effective for primary and secondary skin infections with over 90% bacterial eradication rates 2
• It is particularly effective for impetigo and infected wounds 2, 4
• The topical route delivers high drug concentrations directly to the infection site with minimal systemic absorption 4

Wound Dressing and Care

• Use a simple non-adherent dressing or band-aid to cover the wound after drainage and application of mupirocin 1
• Change the dressing daily or when it becomes soiled 1
• Keep the wound clean with gentle washing
• Elevation of the affected leg is recommended to reduce swelling and promote healing 1
• Continue dressing changes until the wound heals by secondary intention 1

Common Pitfalls to Avoid

• Do not simply apply topical antibiotics without draining the pus—the primary treatment of any abscess is drainage, not antibiotics alone 1
• Do not use antibiotics as a substitute for adequate drainage 1
• Avoid aggressive probing or manipulation that could spread infection 1
• Do not use occlusive dressings that trap moisture and prevent drainage

Monitoring for Complications

Watch for signs that would require medical evaluation:

• Worsening redness, warmth, or swelling despite treatment
• Development of fever or systemic symptoms
• Red streaking from the wound (lymphangitis)
• Failure to improve within 48-72 hours of drainage and topical therapy 1