From the Guidelines
I recommend continuing the current doxycycline treatment and keeping the scheduled follow-up appointment with surgery on Thursday, as the patient is currently stable and not showing signs of systemic illness, and the drainage of pus is a positive sign that the body is fighting the infection and the abscess is decompressing 1. The patient should continue regular dressing changes, keeping the area clean and dry. If the abscess drainage increases significantly, becomes bloody, develops a foul odor, or if the patient develops fever, increasing pain, redness spreading from the site, or feels generally unwell, she should seek immediate medical attention rather than waiting for the scheduled appointment. For home care, the patient should gently clean the area with mild soap and water during dressing changes, apply a clean, dry dressing, and avoid tight clothing that might irritate the area.
Given the patient's advanced age of 88, close monitoring is important as elderly patients can sometimes have atypical presentations of worsening infection without typical symptoms like fever 1. Adequate hydration and proper nutrition will also support healing during this time. The doxycycline is treating the bacterial infection causing the abscess, and as per the guidelines, antibiotic therapy is recommended for abscesses associated with severe or extensive disease, signs and symptoms of systemic illness, associated comorbidities or immunosuppression, extremes of age, or abscess in an area difficult to drain 1.
It's also important to note that the patient's current treatment with doxycycline is in line with the recommended empirical coverage of CA-MRSA in outpatients with SSTI, which includes oral antibiotic options such as doxycycline 1. However, if the patient's condition worsens or does not improve with the current treatment, further evaluation and adjustment of the treatment plan may be necessary, including consideration of other antibiotic options or surgical intervention 1.
From the FDA Drug Label
Incision and drainage or other surgical procedures should be performed in conjunction with antibiotic therapy, when indicated.
The patient is currently on doxycycline (DOxy) and has a draining abscess in the left axilla, with a significant amount of pus. Incision and drainage may be necessary in conjunction with antibiotic therapy. It is recommended to continue with the scheduled follow-up appointment with surgery on Thursday to assess the need for further intervention. 2 2
From the Research
Patient Presentation
The patient is an 88-year-old female presenting with a draining abscess in her left axilla, with a significant amount of pus discharged during a dressing change. She denies any fever, fatigue, nausea, or vomiting and is currently on doxycycline.
Current Treatment and Follow-up
The patient has a follow-up appointment with surgery scheduled for Thursday. The use of systemic antibiotics, such as doxycycline, in the treatment of skin and soft tissue abscesses is a topic of ongoing debate.
Evidence on Systemic Antibiotics for Abscesses
- A 2014 meta-analysis 3 found that systemic antibiotics did not significantly improve the percentage of patients with complete resolution of their abscesses 7-10 days after incision and drainage.
- A 2016 review 4 suggested that incision and drainage alone may be sufficient for the treatment of uncomplicated abscesses, and that wound packing and post-procedural antibiotics may not be necessary.
- However, a 2019 systematic review and meta-analysis 5 found that the use of systemic antibiotics for skin and soft tissue abscesses after incision and drainage resulted in an increased rate of clinical cure.
- A 2021 update on infusion therapy standards of practice 6 emphasized the importance of aligning clinical practice with the most current evidence available.
- A 2024 study 7 found that doxycycline may be a reasonable therapeutic alternative for the treatment of nonpurulent skin and soft tissue infections, particularly in regions with low tetracycline resistance.
Considerations for Patient Care
- The patient's current treatment with doxycycline may be effective in managing her abscess, particularly given the findings of the 2024 study 7.
- However, the decision to continue or modify antibiotic treatment should be made in consultation with the patient's healthcare team, taking into account the latest evidence and guidelines, such as those outlined in the 2019 systematic review and meta-analysis 5.