Management of Large Superficial Shoulder Abscess: Packing Not Recommended
For a large superficial shoulder abscess, packing after incision and drainage is not recommended—simply covering the incision site with sterile gauze is the preferred approach. 1
Primary Treatment Approach
The cornerstone of treatment for any superficial abscess, including those on the shoulder, is incision and drainage (I&D). 1, 2 This should be performed promptly once the diagnosis is established. 2
Post-Drainage Wound Management
Cover the surgical site with a dry sterile dressing only—this is the easiest and most effective treatment of the wound after drainage. 1
Avoid routine packing—a small randomized study found that packing caused more pain and did not improve healing when compared to just covering the incision site with sterile gauze. 1
The evidence against packing comes directly from the Infectious Diseases Society of America (IDSA) guidelines, which represent the highest quality guidance for skin and soft tissue infections. 1
When to Consider Antibiotics
For simple abscesses with adequate drainage, antibiotics are typically unnecessary. 1, 2 However, antibiotics should be added in the following situations:
Systemic inflammatory response syndrome (SIRS) present (temperature >38°C or <36°C, tachycardia >90 bpm, tachypnea >24 breaths/min, or WBC >12,000 or <4,000 cells/µL). 1, 2
Extensive surrounding cellulitis (erythema extending >5 cm beyond wound margins). 2
Immunocompromised patients or those with markedly impaired host defenses. 1, 2
Incomplete source control after drainage. 2
If antibiotics are indicated, empiric therapy should target Staphylococcus aureus (including MRSA) and streptococcal species. 1
Culture Recommendations
Obtain Gram stain and culture of the purulent material from the abscess to guide antibiotic therapy if needed. 1
Treatment without cultures is reasonable in typical cases, but cultures help identify MRSA and guide therapy in complicated cases. 1
Common Pitfalls to Avoid
Do not routinely pack the wound—this increases pain without improving outcomes and adds unnecessary healthcare costs. 1
Do not prescribe antibiotics for simple abscesses after adequate drainage—this provides no clinical benefit and contributes to antibiotic resistance. 1, 2
Do not attempt needle aspiration as an alternative to I&D—this has only 25% success rate overall and <10% success with MRSA infections. 1