I have a rapidly enlarging perianal abscess and I'm already taking Augmentin; should I still go to the emergency department for incision and drainage?

Yes, Go to the Emergency Department Immediately for Incision and Drainage

Even though you are already taking Augmentin, you must go to the emergency department immediately for surgical drainage of your rapidly enlarging perianal abscess—antibiotics alone are insufficient and will lead to treatment failure. 1

Why Antibiotics Alone Will Fail

• Incision and drainage is the cornerstone of treatment for all perianal abscesses and is mandatory—surgical drainage should never be delayed, as antibiotics without drainage are inadequate and result in treatment failure. 1
• An undrained perianal abscess can expand into adjacent spaces and progress to generalized systemic infection, regardless of antibiotic therapy. 1
• The fact that your abscess is rapidly enlarging while on Augmentin demonstrates that the antibiotic is not controlling the infection—this is expected, as source control through drainage is essential. 1

Urgency of Your Situation

• Emergency drainage (within hours) is indicated for patients with sepsis, severe sepsis, septic shock, immunosuppression, diabetes mellitus, or diffuse cellulitis. 1
• Even in the absence of these high-risk factors, surgical drainage should ideally be performed within 24 hours of diagnosis. 1
• The rapidly enlarging nature of your abscess suggests aggressive local infection that requires immediate intervention to prevent extension into deeper spaces. 1

What Happens During Drainage

• Complete drainage is essential, as inadequate drainage is the principal factor for abscess recurrence, with recurrence rates up to 44% when drainage is insufficient. 1
• The incision should be kept as close as possible to the anal verge to minimize potential fistula length while ensuring adequate drainage. 1
• If an obvious low fistula not involving sphincter muscle is found during drainage, fistulotomy should be performed at the same operative session; if the fistula involves any sphincter muscle, only a loose draining seton should be placed. 1

Role of Your Current Augmentin Therapy

• Antibiotics are not routinely indicated after adequate surgical drainage in immunocompetent patients. 1
• Antibiotics should only be considered in cases of sepsis and/or surrounding soft tissue infection, disturbances of immune response, or high-risk patients (immunocompromised, diabetic, or with incomplete source control). 1
• Your current Augmentin may be continued if you have surrounding cellulitis, systemic signs of infection, or are immunocompromised/diabetic, but the primary treatment remains surgical drainage. 1
• Recent evidence shows that antibiotic treatment has no influence on anal fistula formation or recurrent perianal abscess after incision and drainage—the surgery itself is what matters. 2

Common Pitfalls to Avoid

• Do not delay drainage waiting for antibiotics to work—this is the most critical error, as incomplete source control with antibiotics alone leads to treatment failure and potential systemic complications. 1
• Do not assume that because you're on antibiotics, the situation is under control—a rapidly enlarging abscess despite antibiotic therapy is a clear indication for immediate surgical intervention. 1
• Inadequate or timid incisions are a leading cause of recurrence and should be avoided; proper surgical drainage requires adequate exposure. 1