Materiały źródłowe

• #1 Abscess – Wikipedia

  https://en.wikipedia.org/wiki/Abscess

  Standard treatment for most skin or soft tissue abscesses is cutting it open and drainage. There appears to be some benefit from also using antibiotics. A small amount of evidence supports not packing the cavity that remains with gauze after drainage. Closing this cavity right after draining it rather than leaving it open may speed healing without increasing the risk of the abscess returning. Sucking out the pus with a needle is often not sufficient. […] Most people who have an uncomplicated skin abscess should not use antibiotics. Antibiotics in addition to standard incision and drainage is recommended in persons with severe abscesses, many sites of infection, rapid disease progression, the presence of cellulitis, symptoms indicating bacterial illness throughout the body, or a health condition causing immunosuppression. People who are very young or very old may also need antibiotics. If the abscess does not heal only with incision and drainage, or if the abscess is in a place that is difficult to drain such as the face, hands, or genitals, then antibiotics may be indicated. […] Closing an abscess immediately after draining it appears to speed healing without increasing the risk of recurrence. This may not apply to anorectal abscesses as while they may heal faster, there may be a higher rate of recurrence than those left open.

• #2 Abscess: Symptoms, Causes, Treatment, and More

  https://resources.healthgrades.com/right-care/symptoms-and-conditions/abscess

  An abscess is a collection of pus that appears as a lump or swelling. It is a response to an infection that can form internally or on the skin and cause impairment and pain. Treatment involves draining the abscess. […] Treatment for abscesses can depend on the location and severity of the infection. […] Small skin abscesses may improve on their own, which can occur if they drain, shrink, or disappear without treatment. […] Persistent or larger abscesses from a bacterial infection may require antibiotics. […] Other treatment options include a clinician draining the abscess, known as incision and drainage. The wound would then be covered with a bandage. […] Never try to puncture or squeeze a skin abscess because this can spread the infection. […] The main treatment for internal abscesses also involves draining the abscess. This can be done by a surgeon using a fine needle and a small catheter tube to drain the fluid. You may need to wear this catheter for up to a week.

• #3 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  Empiric therapy should cover Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), which causes the vast majority of skin abscesses. […] For patients with signs of systemic toxicity, rapidly progressive or extensive erythema, or an inability to absorb oral therapy, intravenous therapy is warranted. […] Imaging or re-exploration of the wound is indicated for refractory infections to ensure that further drainage is not necessary. […] Other less common causes of refractory infection include resistant organisms, inadequate tissue penetration of antibiotics, and incorrect diagnosis. […] For patients with recurrent MRSA infection despite hygiene optimization or with ongoing transmission among close contacts, we suggest S. aureus decolonization.

• #4 Skin Abscess | IntechOpen

  https://www.intechopen.com/chapters/1173451

  Our skin, which is the largest organ of our body, is one of the organs most prone to abscess formation. […] Although the treatment of these infections varies depending on the patients clinic, it is generally provided with topical or systemic antibiotics. […] Skin abscess formation can occur anywhere on the body. The treatment of bacterial skin infections, defined as pyoderma, can be simple drainage or severe enough to require intensive care conditions, sometimes even resulting in death. […] The most frequently isolated pathogenic microorganisms in bacterial skin infections are Staphylococcus aureus and Streptococcus pyogenes. […] Typically, carbuncles necessitate both medicinal and surgical treatment. Typically, carbuncles are drained and incised while under local anesthetic. […] Oral antibiotics are started following incision and drainage. Dicloxacillin and cephalosporins are typical first-line oral antibiotics. Oral antibiotics such as clindamycin, tetracyclines, trimethoprim-sulfamethoxazole, linezolid, or glycopeptide may be taken if MRSA is suspected or cultivated. […] In recurrent abscesses, culture should be taken and a 510-day treatment should be organized with an antibiotic that is effective for the isolated pathogen. […] When the clinician detects an abscess on the skin, he/she should observe it closely and start antibiotic therapy if necessary.

• #5 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Skin abscesses in adults: Treatment […] This topic will discuss treatment of skin abscesses, including large furuncles and carbuncles. […] To optimize the likelihood of cure, we recommend that all patients with a fluctuant skin abscess undergo incision and drainage to evacuate pus and necrotic debris. […] We suggest antibiotic treatment for all patients undergoing incision and drainage of a skin abscess. […] For patients with multiple antibiotic allergies or intolerances or who prefer to forego antibiotic therapy, it is reasonable to withhold antibiotic therapy if the patient is otherwise healthy and meets all of the following criteria: Single abscess, Size of abscess <2 cm in diameter, No or minimal surrounding cellulitis, No systemic signs of toxicity, No immunosuppression or other comorbidities, No prior clinical failure with incision and drainage alone, No indwelling medical device, No risk factors for infective endocarditis, No exposure to situations that could increase transmission to others.

• #6 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  Skin abscesses in adults: Treatment […] This topic will discuss treatment of skin abscesses, including large furuncles and carbuncles. […] To optimize the likelihood of cure, we recommend that all patients with a fluctuant skin abscess undergo incision and drainage to evacuate pus and necrotic debris. […] In patients with small abscesses (<2 cm) that are spontaneously draining, close observation is an acceptable alternative. [...] We suggest antibiotic treatment for all patients undergoing incision and drainage of a skin abscess. [...] For patients with multiple antibiotic allergies or intolerances or who prefer to forego antibiotic therapy, it is reasonable to withhold antibiotic therapy if the patient is otherwise healthy and meets all of the following criteria: Single abscess, Size of abscess <2 cm in diameter, No or minimal surrounding cellulitis, No systemic signs of toxicity, No immunosuppression or other comorbidities, No prior clinical failure with incision and drainage alone, No indwelling medical device, No risk factors for infective endocarditis, No exposure to situations that could increase transmission to others.

• #7 Abscess: Causes, Symptoms, Tests, and Treatment

  https://www.webmd.com/a-to-z-guides/abscess

  Unlike other infections, antibiotics alone will not usually cure an abscess. In general an abscess must open and drain in order for it to improve. Sometimes draining occurs on its own, but generally it must be opened with the help of a warm compress or by a doctor in a procedure called incision and drainage (ID). […] The doctor may open and drain the abscess. […] The area around the abscess will be numbed with medication. It is often difficult to completely numb the area, but local anesthesia can make the procedure almost painless. […] The doctor will cut open the abscess and totally drain it of pus and debris. […] Once the sore has drained, the doctor may insert some packing into the remaining cavity to allow the infection to continue to drain. It may be kept open for a day or two.

• #8 Skin Abscess: Treatment, Symptoms, Antibiotics, Types, Surgery & At Home

  https://www.emedicinehealth.com/abscess/article_em.htm

  Unlike other infections, antibiotics alone will not typically cure a skin abscess. In general, abscesses must open and drain to improve. Although sometimes an abscess will open and drain spontaneously, it often needs to be lanced (incision and drainage) by a health care provider. Certain abscesses may require a surgical drainage procedure in an operating room. […] Often, a skin abscess will not heal on its own without further intervention by a health care provider. Initially, an abscess may feel firm and hardened (indurated), at which time incision and drainage may not be possible. However, once the abscess begins to „come to a head” and it becomes softer and fluid-filled, minor surgery to lance it to evacuate the pus and relieve the pressure is the best course of action. A doctor will open and drain the abscess (incision and drainage) using the following technique:

• #9 Abscess: Causes, Symptoms, Tests, and Treatment

  https://www.webmd.com/a-to-z-guides/abscess

  Unlike other infections, antibiotics alone will not usually cure an abscess. In general an abscess must open and drain in order for it to improve. Sometimes draining occurs on its own, but generally it must be opened with the help of a warm compress or by a doctor in a procedure called incision and drainage (ID). […] The doctor may open and drain the abscess. […] The area around the abscess will be numbed with medication. It is often difficult to completely numb the area, but local anesthesia can make the procedure almost painless. […] The doctor will cut open the abscess and totally drain it of pus and debris. […] Once the sore has drained, the doctor may insert some packing into the remaining cavity to allow the infection to continue to drain. It may be kept open for a day or two.

• #10 Skin abscess: Pictures, symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/skin-abscess

  If a person has an infected or painful abscess, a healthcare professional will drain it of fluid by making an incision. Beforehand, they may administer local anesthetic to numb the skin. […] They will then flush the cavity with a saline solution. Healthcare professionals typically leave abscesses open to allow any remaining pus to drain out. If an abscess is very deep, the healthcare professional may pack the wound and insert a wick to help it drain. […] Healthcare professionals may prescribe antibiotics to treat the infection. […] At-home care after medical drainage involves slowly removing packed gauze from inside the wound. Sometimes, people will need a healthcare professional to pack the wound multiple times during the healing process. […] People should use moist, warm compresses to encourage wound drainage and prevent the abscess from forming again.

• #11 Abscess: Causes, Symptoms, Tests, and Treatment

  https://www.webmd.com/a-to-z-guides/abscess

  Unlike other infections, antibiotics alone will not usually cure an abscess. In general an abscess must open and drain in order for it to improve. Sometimes draining occurs on its own, but generally it must be opened with the help of a warm compress or by a doctor in a procedure called incision and drainage (ID). […] The doctor may open and drain the abscess. […] The area around the abscess will be numbed with medication. It is often difficult to completely numb the area, but local anesthesia can make the procedure almost painless. […] The doctor will cut open the abscess and totally drain it of pus and debris. […] Once the sore has drained, the doctor may insert some packing into the remaining cavity to allow the infection to continue to drain. It may be kept open for a day or two.

• #12 Abscess: Causes, Symptoms, Tests, and Treatment

  https://www.webmd.com/a-to-z-guides/abscess

  Unlike other infections, antibiotics alone will not usually cure an abscess. In general an abscess must open and drain in order for it to improve. Sometimes draining occurs on its own, but generally it must be opened with the help of a warm compress or by a doctor in a procedure called incision and drainage (ID). […] The doctor may open and drain the abscess. […] The area around the abscess will be numbed with medication. It is often difficult to completely numb the area, but local anesthesia can make the procedure almost painless. […] The doctor will cut open the abscess and totally drain it of pus and debris. […] Once the sore has drained, the doctor may insert some packing into the remaining cavity to allow the infection to continue to drain. It may be kept open for a day or two.

• #13 Abscess: Causes, Symptoms, Tests, and Treatment

  https://www.webmd.com/a-to-z-guides/abscess

  Unlike other infections, antibiotics alone will not usually cure an abscess. In general an abscess must open and drain in order for it to improve. Sometimes draining occurs on its own, but generally it must be opened with the help of a warm compress or by a doctor in a procedure called incision and drainage (ID). […] The doctor may open and drain the abscess. […] The area around the abscess will be numbed with medication. It is often difficult to completely numb the area, but local anesthesia can make the procedure almost painless. […] The doctor will cut open the abscess and totally drain it of pus and debris. […] Once the sore has drained, the doctor may insert some packing into the remaining cavity to allow the infection to continue to drain. It may be kept open for a day or two.

• #14 Abscess: Causes, Symptoms, Tests, and Treatment

  https://www.webmd.com/a-to-z-guides/abscess

  A bandage will then be placed over the packing, and you will be given instructions about home care. […] Most people feel better immediately after the abscess is drained. […] If you are still experiencing pain, the doctor may prescribe pain pills for home use over the next 1-2 days. […] You are usually sent home with oral antibiotics.

• #15 Abscess: Causes, Symptoms, Tests, and Treatment

  https://www.webmd.com/a-to-z-guides/abscess

  A bandage will then be placed over the packing, and you will be given instructions about home care. […] Most people feel better immediately after the abscess is drained. […] If you are still experiencing pain, the doctor may prescribe pain pills for home use over the next 1-2 days. […] You are usually sent home with oral antibiotics.

• #16 Skin Abscess – TeachMeSurgery

  https://teachmesurgery.com/plastic-surgery/infections/skin-abscess/

  Incision and drainage allows for drainage of the pus to ensure appropriate source control, reducing the potential overall morbidity and the subsequent risk of recurrence. […] If left untreated, the infective process may progress into further cellulitis, necrotising fasciitis, or sepsis. […] Key Points: A skin abscess is a collection of pus within the subcutaneous tissues, lined by a pyogenic membrane; Diagnosis is mainly clinical; Definitive management is with an incision and drainage.

• #17 Cutaneous Abscess – Management : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/cutaneous-abscess-management/

  Cutaneous abscesses are common in the emergency department and incidence has increased, likely due to the emergence of community-associated methicillin resistant staphylococcus aureus (CA-MRSA) as a major pathogen. […] The treatment of abscesses is incision and drainage; antibiotics are not routinely needed in absence of surrounding cellulitis. […] However, in areas where the rates of CA-MRSA is high (>30%), treatment with a 7 day course of TMP-SMX is associated with higher cure rates. […] Doxycycline is a reasonable alternative (5-7 days at 100 mg PO BID). Sensitivity of CA-MRSA to TMP-SMX or doxycycline remains > 90%. […] Proper abscess drainage is important and the incision should be up to half of the width of the abscess. […] Packing, while historically carried out, results in greater pain and has not been shown to improve outcomes. […] Culture and sensitivity of abscess drainage material is not essential, but useful to establish local patterns of bacterial pathogens. […] Most patients with cutaneous abscesses may be safely discharged home unless there are mitigating circumstances (social, etc).

• #18 The Treatment of Cutaneous Abscesses: Comparison of Emergency Medicine Providers’ Practice Patterns

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3582519/

  Cutaneous abscesses are commonly treated in the emergency department (ED). Although incision and drainage (ID) remains the standard treatment, there is little high-quality evidence to support additional interventions such as pain control, type of incision, and use of irrigation, wound cultures, and packing. […] Most providers (76%) used narcotics for pain management, 71% used local anesthetic over the roof of the abscess, and 60% used local anesthetic in a field block for pain control. More than 48% of responders routinely used irrigation after (ID). Eighty-five percent of responders used a linear incision to drain the abscess and 91% used packing in the wound cavity. […] Variability exists in the treatment strategies for abscess care. Most providers used narcotic analgesics in addition to local anesthetic, linear incisions, and packing. Most providers did not irrigate, order wound cultures, or routinely prescribe oral antibiotics unless specific risk factors or physical signs were present.

• #19 The Treatment of Cutaneous Abscesses: Comparison of Emergency Medicine Providers’ Practice Patterns

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3582519/

  Most texts and guidelines suggest incision and drainage as the treatment for uncomplicated superficial cutaneous abscesses; however, there is no standard definition of the procedure and little evidence to support the additional steps involved. […] The use of gentle packing is generally recommended by current guidelines to prevent premature wound closure and allow continuous drainage after ID. However, the theory behind wound packing is based on consensus guidelines rather than evidence-based data and is performed at the discretion of the provider. […] Although the 2011 Infectious Diseases Society of America guidelines recommend wound cultures in certain circumstances, the routine use of wound cultures in uncomplicated abscesses in otherwise healthy individuals is often unnecessary in the ED. […] While this practice follows guidelines, textbooks, and recommendations from recent studies, it is significantly less than the antibiotic use of 53% to 80% reported in previous studies.

• #20 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Recurrences of skin abscesses are not uncommon, occurring in 7 to 14 percent of individuals within two months of completing therapy. […] The mainstay of prevention includes attention to personal hygiene, decolonization, and consideration of the possibility of household or interpersonal transmission. […] For patients with recurrent MRSA infection despite hygiene optimization or with ongoing transmission among close contacts, we suggest S. aureus decolonization. […] This topic discusses treatment of skin abscesses, including large furuncles and carbuncles. […] Fluctuant skin abscesses generally require incision and drainage to evacuate pus and necrotic debris. […] For all patients undergoing incision and drainage of a skin abscess, we suggest antibiotic therapy because it reduces the rate of treatment failure and recurrence.

• #21 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  Skin abscesses in adults: Treatment […] This topic will discuss treatment of skin abscesses, including large furuncles and carbuncles. […] To optimize the likelihood of cure, we recommend that all patients with a fluctuant skin abscess undergo incision and drainage to evacuate pus and necrotic debris. […] In patients with small abscesses (<2 cm) that are spontaneously draining, close observation is an acceptable alternative. [...] We suggest antibiotic treatment for all patients undergoing incision and drainage of a skin abscess. [...] For patients with multiple antibiotic allergies or intolerances or who prefer to forego antibiotic therapy, it is reasonable to withhold antibiotic therapy if the patient is otherwise healthy and meets all of the following criteria: Single abscess, Size of abscess <2 cm in diameter, No or minimal surrounding cellulitis, No systemic signs of toxicity, No immunosuppression or other comorbidities, No prior clinical failure with incision and drainage alone, No indwelling medical device, No risk factors for infective endocarditis, No exposure to situations that could increase transmission to others.

• #22 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Skin abscesses in adults: Treatment […] This topic will discuss treatment of skin abscesses, including large furuncles and carbuncles. […] To optimize the likelihood of cure, we recommend that all patients with a fluctuant skin abscess undergo incision and drainage to evacuate pus and necrotic debris. […] We suggest antibiotic treatment for all patients undergoing incision and drainage of a skin abscess. […] For patients with multiple antibiotic allergies or intolerances or who prefer to forego antibiotic therapy, it is reasonable to withhold antibiotic therapy if the patient is otherwise healthy and meets all of the following criteria: Single abscess, Size of abscess <2 cm in diameter, No or minimal surrounding cellulitis, No systemic signs of toxicity, No immunosuppression or other comorbidities, No prior clinical failure with incision and drainage alone, No indwelling medical device, No risk factors for infective endocarditis, No exposure to situations that could increase transmission to others.

• #23 Cutaneous Abscess – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/cutaneous-abscess

  A cutaneous abscess is a localized collection of pus in the skin and may occur on any skin surface. […] Treatment is incision and drainage and sometimes antibiotics. […] Incision and drainage are indicated when significant pain, tenderness, and swelling are present; it is unnecessary to await fluctuance. […] Antibiotics have traditionally been considered unnecessary unless the patient has signs of systemic infection, cellulitis, multiple abscesses, immunocompromise, or a facial abscess in the area drained by the cavernous sinus. […] However, subsequent studies have suggested lower rates of treatment failure and recurrence when antibiotics are added for any abscess that requires treatment in locations where MRSA is prevalent. […] Drain abscesses accompanied by significant pain, tenderness, and swelling and provide adequate analgesia and, when indicated, sedation. […] Give antibiotics if the patient has signs of systemic infection, cellulitis, multiple abscesses, immunocompromise, or a facial abscess.

• #24 Management of Cutaneous Abscesses by Dermatologists – JDDonline – Journal of Drugs in Dermatology

  https://jddonline.com/articles/management-of-cutaneous-abscesses-by-dermatologists-S1545961614P0119X

  99% of respondents were capable of performing I+D in their practice. […] The IDSA recommends cultures in all patients treated with antibiotic therapy, and does not recommend antibiotics for the treatment of simple abscess. […] For facial abscesses, as the age of the patient increased from infant, respondents were more likely to incorporate I+D into their initial treatment. […] Although most dermatologists were prepared to manage uncomplicated abscesses (98%), this survey identifies gaps in clinical standards of care established by the CDC/IDSA. […] The Infectious Diseases Society of America recommends antibiotic treatment only after incision and drainage of an abscess when there is (a) severe of extensive disease, (b) signs and symptoms of systemic disease, (c) associated comorbidities of immunosuppression, (d) extremes in age, (e) abscess in an area difficult to drain completely (face, hand, genitalia), (f) associated septic phlebitis, (g) lack of response to incision and drainage alone. […] When antibiotic treatment is indicated for the treatment of acute bacterial skin and skin structure infections (ABSSSI), the IDSA recommends empiric coverage of CA- MRSA in the outpatient setting, pending culture results.

• #25 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Empiric therapy should cover Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), which causes the vast majority of skin abscesses. […] We suggest vancomycin for patients with sepsis or an immunocompromising condition, we combine vancomycin with cefepime to provide a broader spectrum of coverage. […] The goal of therapy is to achieve resolution of the abscess and surrounding cellulitis. […] Imaging or re-exploration of the wound is indicated for refractory infections to ensure that further drainage is not necessary. […] Causes of recurrences include suboptimal personal hygiene and interpersonal transmission.

• #26 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  Empiric therapy should cover Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), which causes the vast majority of skin abscesses. […] For patients with signs of systemic toxicity, rapidly progressive or extensive erythema, or an inability to absorb oral therapy, intravenous therapy is warranted. […] Imaging or re-exploration of the wound is indicated for refractory infections to ensure that further drainage is not necessary. […] Other less common causes of refractory infection include resistant organisms, inadequate tissue penetration of antibiotics, and incorrect diagnosis. […] For patients with recurrent MRSA infection despite hygiene optimization or with ongoing transmission among close contacts, we suggest S. aureus decolonization.

• #27 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  For most patients with skin abscess, oral antibiotic therapy is sufficient. […] We suggest trimethoprim-sulfamethoxazole, doxycycline, or minocycline. […] Intravenous therapy is warranted for patients with signs of systemic toxicity, rapidly progressive or extensive erythema, or an inability to absorb oral therapy. […] The duration of therapy should be individualized based on clinical response. […] Patients are typically treated for five days; extension of the duration may be warranted in the setting of severe infection, slow response to therapy, or immunosuppression. […] The goal of therapy is to achieve resolution of the abscess and surrounding cellulitis. […] Despite incision and drainage and a complete course of antibiotics, abscesses fail to resolve in approximately 10 percent of patients.

• #28 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  For most patients with skin abscess, oral antibiotic therapy is sufficient. […] We suggest trimethoprim-sulfamethoxazole, doxycycline, or minocycline. […] The duration of therapy should be individualized based on clinical response. […] Patients are typically treated for five days; extension of the duration (up to 14 days) may be warranted in the setting of severe infection, slow response to therapy, or immunosuppression. […] Patients receiving outpatient therapy should have follow-up evaluation after treatment initiation to verify clinical response. […] The goal of therapy is to achieve resolution of the abscess and surrounding cellulitis. […] Despite incision and drainage and a complete course of antibiotics, abscesses fail to resolve in approximately 10 percent of patients. […] Failure to improve after incision and drainage and 24 to 48 hours of appropriate antibiotic therapy should prompt assessment for possible reasons for nonresponse.

• #29 Skin Abscess: Causes, Diagnosis, and Treatment

  https://www.healthline.com/health/skin-abscess

  After the procedure is over, your doctor will likely prescribe antibiotics to prevent the wound from becoming infected. […] Your doctor might prescribe an oral antibiotic depending on the appearance and symptoms of the abscess. The antibiotics that are typically prescribed in this instance include: clindamycin, cephalexin, dicloxacillin, doxycycline, trimethoprim-sulfamethoxazole (Bactrim). […] In some cases, an individual with comorbid conditions (which occur at the same time) or severe infection may require hospitalization and will be given antibiotics through their vein. […] After treatment, the abscess shouldn’t return.

• #30 Antibiotics for Uncomplicated Skin Abscesses After Incision and Drainage: BMJ Rapid Recommendation | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0901/p323.html

  TMP-SMX or clindamycin can be combined with incision and drainage of skin abscesses to decrease the risk of treatment failure and recurrence. […] Based on high-quality evidence, trimethoprim/sulfamethoxazole (TMP-SMX) or clindamycin combined with incision and drainage has been shown to decrease the risk of treatment failure by approximately 5% at one month and the risk of recurrence by approximately 8% at three months compared with no antibiotic treatment. […] There is no crucial difference in treatment failure between TMP-SMX and clindamycin, and both have similar risk of recurrence. […] TMP-SMX is usually inexpensive, whereas clindamycin can be expensive in some areas. […] For this reason, believing that most patients would want to take an antibiotic that has been demonstrated to be effective, including TMP-SMX or clindamycin, the panel strongly recommends against the use of cephalosporins.

• #31 Antibiotics for Uncomplicated Skin Abscesses After Incision and Drainage: BMJ Rapid Recommendation | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0901/p323.html

  TMP-SMX or clindamycin can be combined with incision and drainage of skin abscesses to decrease the risk of treatment failure and recurrence. […] Based on high-quality evidence, trimethoprim/sulfamethoxazole (TMP-SMX) or clindamycin combined with incision and drainage has been shown to decrease the risk of treatment failure by approximately 5% at one month and the risk of recurrence by approximately 8% at three months compared with no antibiotic treatment. […] There is no crucial difference in treatment failure between TMP-SMX and clindamycin, and both have similar risk of recurrence. […] TMP-SMX is usually inexpensive, whereas clindamycin can be expensive in some areas. […] For this reason, believing that most patients would want to take an antibiotic that has been demonstrated to be effective, including TMP-SMX or clindamycin, the panel strongly recommends against the use of cephalosporins.

• #32 Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis | BMJ Open

  https://bmjopen.bmj.com/content/8/2/e020991

  Objective To assess the impact of adjunctive antibiotic therapy on uncomplicated skin abscesses. […] Results Fourteen RCTs including 4198 patients proved eligible. Compared with no antibiotics, antibiotics probably lower the risk of treatment failure (OR 0.58, 95%CI 0.37 to 0.90; low quality), recurrence within 1 month (OR 0.48, 95% CI 0.30 to 0.77; moderate quality), hospitalisation (OR 0.55, 95% CI 0.32 to 0.94; moderate quality) and late recurrence (OR 0.64, 95% CI 0.48 to 0.85; moderate quality). […] Conclusions In patients with uncomplicated skin abscesses, moderate-to-high quality evidence suggests TMP-SMX or clindamycin confer a modest benefit for several important outcomes, but this is offset by a similar risk of adverse effects. Clindamycin has a substantially higher risk of diarrhoea than TMP-SMX. Cephalosporins are probably not effective.

• #33 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  For most patients with skin abscess, oral antibiotic therapy is sufficient. […] We suggest trimethoprim-sulfamethoxazole, doxycycline, or minocycline. […] Intravenous therapy is warranted for patients with signs of systemic toxicity, rapidly progressive or extensive erythema, or an inability to absorb oral therapy. […] The duration of therapy should be individualized based on clinical response. […] Patients are typically treated for five days; extension of the duration may be warranted in the setting of severe infection, slow response to therapy, or immunosuppression. […] The goal of therapy is to achieve resolution of the abscess and surrounding cellulitis. […] Despite incision and drainage and a complete course of antibiotics, abscesses fail to resolve in approximately 10 percent of patients.

• #34 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  We suggest that antimicrobials be administered prior to incision and drainage for patients whose incision and drainage cannot be performed promptly, patients who have an indication for parenteral therapy, and patients with risk factors for infective endocarditis. […] Patients with skin abscess should receive empiric therapy that covers S. aureus, including MRSA. […] The decision to initiate parenteral therapy is typically based on the extent and severity of infection and patient comorbidities. […] For individuals with skin abscess, we suggest initial treatment with parenteral antibiotics in the following circumstances: Systemic signs of toxicity, Rapid progression of erythema or abscess, Extensive abscess or surrounding erythema, Immunocompromising condition, Inability to tolerate or absorb oral therapy.

• #35 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  For most patients, we suggest withholding antimicrobial therapy until after samples for culture have been obtained to optimize culture results. […] However, for certain patients, we suggest that antimicrobials be administered prior to incision and drainage: Patients whose incision and drainage cannot be performed promptly, Patients who have an indication for parenteral therapy. […] The choice of antibiotic is typically dependent on the suspected microorganisms, severity of illness, and patient allergies and comorbidities. […] Patients with skin abscess should receive empiric therapy that covers S. aureus, including MRSA. […] For individuals with skin abscess, we suggest initial treatment with parenteral antibiotics in the following circumstances: Systemic signs of toxicity, Rapid progression of erythema or abscess, Extensive abscess or surrounding erythema, Immunocompromising condition, Inability to tolerate or absorb oral therapy.

• #36 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Empiric therapy should cover Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), which causes the vast majority of skin abscesses. […] We suggest vancomycin for patients with sepsis or an immunocompromising condition, we combine vancomycin with cefepime to provide a broader spectrum of coverage. […] The goal of therapy is to achieve resolution of the abscess and surrounding cellulitis. […] Imaging or re-exploration of the wound is indicated for refractory infections to ensure that further drainage is not necessary. […] Causes of recurrences include suboptimal personal hygiene and interpersonal transmission.

• #37 Cellulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/214222-overview

  Treatment of recurrent disease (usually related to venous or lymphatic obstruction) is as follows: The cellulitis is most often due to Streptococcus species; daily amoxicillin or a macrolide may be effective for prevention of recurrences. […] If tinea pedis is suspected to be the predisposing cause, treat with topical or systemic antifungals. […] Compressive therapy has been shown to decrease risk for recurrence in patients with chronic edema and recurrent cellulitis. […] Patients with severe cellulitis require parenteral therapy, such as the following: Cefazolin, cefuroxime, ceftriaxone, nafcillin, or oxacillin for presumed staphylococcal or streptococcal infection. […] Clindamycin or vancomycin for penicillin-allergic patients. […] Broad gram-positive, gram-negative, and anaerobic coverage for cases associated with diabetic ulcers.

• #38 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  For most patients with skin abscess, oral antibiotic therapy is sufficient. […] We suggest trimethoprim-sulfamethoxazole, doxycycline, or minocycline. […] Intravenous therapy is warranted for patients with signs of systemic toxicity, rapidly progressive or extensive erythema, or an inability to absorb oral therapy. […] The duration of therapy should be individualized based on clinical response. […] Patients are typically treated for five days; extension of the duration may be warranted in the setting of severe infection, slow response to therapy, or immunosuppression. […] The goal of therapy is to achieve resolution of the abscess and surrounding cellulitis. […] Despite incision and drainage and a complete course of antibiotics, abscesses fail to resolve in approximately 10 percent of patients.

• #39 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  For most patients with skin abscess, oral antibiotic therapy is sufficient. […] We suggest trimethoprim-sulfamethoxazole, doxycycline, or minocycline. […] The duration of therapy should be individualized based on clinical response. […] Patients are typically treated for five days; extension of the duration (up to 14 days) may be warranted in the setting of severe infection, slow response to therapy, or immunosuppression. […] Patients receiving outpatient therapy should have follow-up evaluation after treatment initiation to verify clinical response. […] The goal of therapy is to achieve resolution of the abscess and surrounding cellulitis. […] Despite incision and drainage and a complete course of antibiotics, abscesses fail to resolve in approximately 10 percent of patients. […] Failure to improve after incision and drainage and 24 to 48 hours of appropriate antibiotic therapy should prompt assessment for possible reasons for nonresponse.

• #40 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  For most patients with skin abscess, oral antibiotic therapy is sufficient. […] We suggest trimethoprim-sulfamethoxazole, doxycycline, or minocycline. […] The duration of therapy should be individualized based on clinical response. […] Patients are typically treated for five days; extension of the duration (up to 14 days) may be warranted in the setting of severe infection, slow response to therapy, or immunosuppression. […] Patients receiving outpatient therapy should have follow-up evaluation after treatment initiation to verify clinical response. […] The goal of therapy is to achieve resolution of the abscess and surrounding cellulitis. […] Despite incision and drainage and a complete course of antibiotics, abscesses fail to resolve in approximately 10 percent of patients. […] Failure to improve after incision and drainage and 24 to 48 hours of appropriate antibiotic therapy should prompt assessment for possible reasons for nonresponse.

• #41 Skin and Soft Tissue Infections | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p474.html

  In uncomplicated cellulitis, five days of treatment is as effective as 10 days. […] Inpatient treatment is necessary for patients who have uncontrolled infection despite adequate outpatient antimicrobial therapy or who cannot tolerate oral antibiotics. […] Broad-spectrum antibiotics with proven effectiveness against gram-positive and gram-negative organisms and anaerobes should be used until pathogen-specific sensitivities are available; coverage can then be narrowed. […] The recommended duration of antibiotic therapy for hospitalized patients is seven to 14 days. […] The antibiotic spectrum can be narrowed once the infecting microbes are identified and susceptibility testing results are available.

• #42 Skin Abscess: Causes, Diagnosis, and Treatment

  https://www.healthline.com/health/skin-abscess

  Most skin abscesses are harmless and may go away without treatment. Over-the-counter (OTC) creams such as topical antibiotic creams and at-home care may decrease swelling and aid in healing in minor cases. […] Sometimes, skin abscesses are more difficult to treat and may require laceration (cutting) or drainage. In other cases, oral antibiotics may be prescribed along with prescription washes in addition to draining. […] You can usually treat a skin abscess at home. Applying heat to the abscess can help it shrink and drain. […] Contact your doctor if the abscess doesn’t heal using home methods. They may want to drain it. […] To drain the abscess, your doctor will apply a local numbing substance, such as lidocaine, and will then cut the abscess open to allow the fluid to come out. The open abscess is then washed out with saline.

• #43 Skin abscess: Pictures, symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/skin-abscess

  It is also possible to treat boils at home using: a heat pack to increase blood flow and help fight infection, over-the-counter (OTC) medications, such as antibiotic ointments, to soothe the skin, speed healing, and prevent infection, other OTC medications, such as nonsteroidal anti-inflammatory drugs, to help with pain and swelling. […] People should not try to drain an abscess at home. If a person does this, they risk introducing bacteria into the wound, which can lead to complications. […] While most skin abscesses are nothing to worry about, some may require a healthcare professional’s attention. People can treat a small abscess at home by applying heat to shrink and drain it. […] If an abscess is large or infected, a healthcare professional will cut it open to drain the fluid buildup. […] If someone suspects they have an infected abscess, they should seek medical attention. Untreated infected abscesses are potentially life threatening, especially if the infection is the result of MRSA.

• #44 Skin abscess: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000863.htm

  A skin abscess is a buildup of pus in or on the skin. […] You can apply moist heat (such as warm compresses) to help the abscess drain and heal faster. Do not push and squeeze on the abscess. […] Your provider may cut open the abscess and drain it. If this is done: Numbing medicine will be put on or into your skin. Packing material may be left in the wound to help it heal. […] You may need to take antibiotics by mouth to control the infection. […] Most skin abscesses can be cured with proper treatment. Infections caused by MRSA respond to specific antibiotics.

• #45 Skin Abscess: Causes, Diagnosis, and Treatment

  https://www.healthline.com/health/skin-abscess

  Most skin abscesses are harmless and may go away without treatment. Over-the-counter (OTC) creams such as topical antibiotic creams and at-home care may decrease swelling and aid in healing in minor cases. […] Sometimes, skin abscesses are more difficult to treat and may require laceration (cutting) or drainage. In other cases, oral antibiotics may be prescribed along with prescription washes in addition to draining. […] You can usually treat a skin abscess at home. Applying heat to the abscess can help it shrink and drain. […] Contact your doctor if the abscess doesn’t heal using home methods. They may want to drain it. […] To drain the abscess, your doctor will apply a local numbing substance, such as lidocaine, and will then cut the abscess open to allow the fluid to come out. The open abscess is then washed out with saline.

• #46 Managing Skin Infections & Abscesses: How Urgent Care Can Help

  https://www.urgentcaremds.com/skin-infection-and-abscess-treatment-at-urgent-care/

  Topical treatments such as antibacterial ointments or creams may be recommended for minor skin infections or abscesses. […] Keeping the affected area clean and dry is essential for preventing further infection and promoting healing. […] One of the most significant advantages of urgent care is receiving immediate attention for skin infections or abscesses. […] Urgent care facilities are staffed with experienced healthcare professionals, including physicians, nurse practitioners, and physician assistants. […] Urgent care providers can initiate treatment promptly once your skin infection or abscess is diagnosed.

• #47 Skin Abscesses (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/abscess.html

  A skin abscess is the body’s way of trying to heal from an infection. It can form after germs, usually bacteria, get into a cut in the skin and cause an infection. […] Abscesses get better after they open and the pus drains out. Applying a warm compress can help that happen. To make a compress, wet a washcloth with warm (not hot) water and place it over the abscess for several minutes. Do this a few times a day. Always wash your hands well before and after touching the abscess. […] If a skin abscess doesnt drain on its own, call your doctor. Sometimes skin abscesses need to be drained by the doctor. The doctor will apply a numbing medicine, then make a tiny cut in the top of the abscess to let the pus drain out. The cut is left open to drain and then heal on its own. Some abscesses get treated with antibiotics too, but this isn’t always needed. If your child needs to take antibiotics, make sure to give all the doses as directed, even if they feel better. This is the best way to kill all the bacteria. […] Make sure your child avoids touching, pushing, popping, or squeezing the abscess because that can spread the infection to other parts of the skin, making things worse.

• #48 Skin abscess: Pictures, symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/skin-abscess

  It is also possible to treat boils at home using: a heat pack to increase blood flow and help fight infection, over-the-counter (OTC) medications, such as antibiotic ointments, to soothe the skin, speed healing, and prevent infection, other OTC medications, such as nonsteroidal anti-inflammatory drugs, to help with pain and swelling. […] People should not try to drain an abscess at home. If a person does this, they risk introducing bacteria into the wound, which can lead to complications. […] While most skin abscesses are nothing to worry about, some may require a healthcare professional’s attention. People can treat a small abscess at home by applying heat to shrink and drain it. […] If an abscess is large or infected, a healthcare professional will cut it open to drain the fluid buildup. […] If someone suspects they have an infected abscess, they should seek medical attention. Untreated infected abscesses are potentially life threatening, especially if the infection is the result of MRSA.

• #49 Skin Abscess: Causes, Diagnosis, and Treatment

  https://www.healthline.com/health/skin-abscess

  Most skin abscesses are harmless and may go away without treatment. Over-the-counter (OTC) creams such as topical antibiotic creams and at-home care may decrease swelling and aid in healing in minor cases. […] Sometimes, skin abscesses are more difficult to treat and may require laceration (cutting) or drainage. In other cases, oral antibiotics may be prescribed along with prescription washes in addition to draining. […] You can usually treat a skin abscess at home. Applying heat to the abscess can help it shrink and drain. […] Contact your doctor if the abscess doesn’t heal using home methods. They may want to drain it. […] To drain the abscess, your doctor will apply a local numbing substance, such as lidocaine, and will then cut the abscess open to allow the fluid to come out. The open abscess is then washed out with saline.

• #50 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  For most patients with skin abscess, oral antibiotic therapy is sufficient. […] We suggest trimethoprim-sulfamethoxazole, doxycycline, or minocycline. […] Intravenous therapy is warranted for patients with signs of systemic toxicity, rapidly progressive or extensive erythema, or an inability to absorb oral therapy. […] The duration of therapy should be individualized based on clinical response. […] Patients are typically treated for five days; extension of the duration may be warranted in the setting of severe infection, slow response to therapy, or immunosuppression. […] The goal of therapy is to achieve resolution of the abscess and surrounding cellulitis. […] Despite incision and drainage and a complete course of antibiotics, abscesses fail to resolve in approximately 10 percent of patients.

• #51 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  For most patients with skin abscess, oral antibiotic therapy is sufficient. […] We suggest trimethoprim-sulfamethoxazole, doxycycline, or minocycline. […] The duration of therapy should be individualized based on clinical response. […] Patients are typically treated for five days; extension of the duration (up to 14 days) may be warranted in the setting of severe infection, slow response to therapy, or immunosuppression. […] Patients receiving outpatient therapy should have follow-up evaluation after treatment initiation to verify clinical response. […] The goal of therapy is to achieve resolution of the abscess and surrounding cellulitis. […] Despite incision and drainage and a complete course of antibiotics, abscesses fail to resolve in approximately 10 percent of patients. […] Failure to improve after incision and drainage and 24 to 48 hours of appropriate antibiotic therapy should prompt assessment for possible reasons for nonresponse.

• #52 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  For most patients with skin abscess, oral antibiotic therapy is sufficient. […] We suggest trimethoprim-sulfamethoxazole, doxycycline, or minocycline. […] The duration of therapy should be individualized based on clinical response. […] Patients are typically treated for five days; extension of the duration (up to 14 days) may be warranted in the setting of severe infection, slow response to therapy, or immunosuppression. […] Patients receiving outpatient therapy should have follow-up evaluation after treatment initiation to verify clinical response. […] The goal of therapy is to achieve resolution of the abscess and surrounding cellulitis. […] Despite incision and drainage and a complete course of antibiotics, abscesses fail to resolve in approximately 10 percent of patients. […] Failure to improve after incision and drainage and 24 to 48 hours of appropriate antibiotic therapy should prompt assessment for possible reasons for nonresponse.

• #53 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  Empiric therapy should cover Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), which causes the vast majority of skin abscesses. […] For patients with signs of systemic toxicity, rapidly progressive or extensive erythema, or an inability to absorb oral therapy, intravenous therapy is warranted. […] Imaging or re-exploration of the wound is indicated for refractory infections to ensure that further drainage is not necessary. […] Other less common causes of refractory infection include resistant organisms, inadequate tissue penetration of antibiotics, and incorrect diagnosis. […] For patients with recurrent MRSA infection despite hygiene optimization or with ongoing transmission among close contacts, we suggest S. aureus decolonization.

• #54 Cellulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/214222-overview

  Coverage for MRSA, until culture and sensitivity information become available, for severe cellulitis apparently related to a furuncle or an abscess. […] For cellulitis involving wounds sustained in an aquatic environment, recommended antibiotic regimens vary with the type of water involved. […] Lack of response to an appropriate antibiotic regimen should raise suspicion for Mycobacterium marinum infection and suggest wound biopsy for mycobacterial stains and culture.

• #55 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Empiric therapy should cover Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), which causes the vast majority of skin abscesses. […] We suggest vancomycin for patients with sepsis or an immunocompromising condition, we combine vancomycin with cefepime to provide a broader spectrum of coverage. […] The goal of therapy is to achieve resolution of the abscess and surrounding cellulitis. […] Imaging or re-exploration of the wound is indicated for refractory infections to ensure that further drainage is not necessary. […] Causes of recurrences include suboptimal personal hygiene and interpersonal transmission.

• #56 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  Empiric therapy should cover Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), which causes the vast majority of skin abscesses. […] For patients with signs of systemic toxicity, rapidly progressive or extensive erythema, or an inability to absorb oral therapy, intravenous therapy is warranted. […] Imaging or re-exploration of the wound is indicated for refractory infections to ensure that further drainage is not necessary. […] Other less common causes of refractory infection include resistant organisms, inadequate tissue penetration of antibiotics, and incorrect diagnosis. […] For patients with recurrent MRSA infection despite hygiene optimization or with ongoing transmission among close contacts, we suggest S. aureus decolonization.

• #57 Cellulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/214222-overview

  Coverage for MRSA, until culture and sensitivity information become available, for severe cellulitis apparently related to a furuncle or an abscess. […] For cellulitis involving wounds sustained in an aquatic environment, recommended antibiotic regimens vary with the type of water involved. […] Lack of response to an appropriate antibiotic regimen should raise suspicion for Mycobacterium marinum infection and suggest wound biopsy for mycobacterial stains and culture.

• #58 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Recurrences of skin abscesses are not uncommon, occurring in 7 to 14 percent of individuals within two months of completing therapy. […] The mainstay of prevention includes attention to personal hygiene, decolonization, and consideration of the possibility of household or interpersonal transmission. […] For patients with recurrent MRSA infection despite hygiene optimization or with ongoing transmission among close contacts, we suggest S. aureus decolonization. […] This topic discusses treatment of skin abscesses, including large furuncles and carbuncles. […] Fluctuant skin abscesses generally require incision and drainage to evacuate pus and necrotic debris. […] For all patients undergoing incision and drainage of a skin abscess, we suggest antibiotic therapy because it reduces the rate of treatment failure and recurrence.

• #59 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  Recurrences of skin abscesses are not uncommon, occurring in 7 to 14 percent of individuals within two months of completing therapy. […] Management of recurrent infections during the active stage of infection is the same as initial episodes. […] The mainstay of prevention includes attention to personal hygiene, decolonization, and consideration of the possibility of household or interpersonal transmission. […] There are little to no data to support the use of suppressive antibiotics to prevent recurrent skin abscesses. […] This topic discusses treatment of skin abscesses, including large furuncles and carbuncles. […] Fluctuant skin abscesses generally require incision and drainage to evacuate pus and necrotic debris. […] For all patients undergoing incision and drainage of a skin abscess, we suggest antibiotic therapy because it reduces the rate of treatment failure and recurrence. […] We feel most strongly about using antibiotics for those at highest risk.

• #60 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Recurrences of skin abscesses are not uncommon, occurring in 7 to 14 percent of individuals within two months of completing therapy. […] The mainstay of prevention includes attention to personal hygiene, decolonization, and consideration of the possibility of household or interpersonal transmission. […] For patients with recurrent MRSA infection despite hygiene optimization or with ongoing transmission among close contacts, we suggest S. aureus decolonization. […] This topic discusses treatment of skin abscesses, including large furuncles and carbuncles. […] Fluctuant skin abscesses generally require incision and drainage to evacuate pus and necrotic debris. […] For all patients undergoing incision and drainage of a skin abscess, we suggest antibiotic therapy because it reduces the rate of treatment failure and recurrence.

• #61 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  Recurrences of skin abscesses are not uncommon, occurring in 7 to 14 percent of individuals within two months of completing therapy. […] Management of recurrent infections during the active stage of infection is the same as initial episodes. […] The mainstay of prevention includes attention to personal hygiene, decolonization, and consideration of the possibility of household or interpersonal transmission. […] There are little to no data to support the use of suppressive antibiotics to prevent recurrent skin abscesses. […] This topic discusses treatment of skin abscesses, including large furuncles and carbuncles. […] Fluctuant skin abscesses generally require incision and drainage to evacuate pus and necrotic debris. […] For all patients undergoing incision and drainage of a skin abscess, we suggest antibiotic therapy because it reduces the rate of treatment failure and recurrence. […] We feel most strongly about using antibiotics for those at highest risk.

• #62 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Recurrences of skin abscesses are not uncommon, occurring in 7 to 14 percent of individuals within two months of completing therapy. […] The mainstay of prevention includes attention to personal hygiene, decolonization, and consideration of the possibility of household or interpersonal transmission. […] For patients with recurrent MRSA infection despite hygiene optimization or with ongoing transmission among close contacts, we suggest S. aureus decolonization. […] This topic discusses treatment of skin abscesses, including large furuncles and carbuncles. […] Fluctuant skin abscesses generally require incision and drainage to evacuate pus and necrotic debris. […] For all patients undergoing incision and drainage of a skin abscess, we suggest antibiotic therapy because it reduces the rate of treatment failure and recurrence.

• #63 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  Empiric therapy should cover Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), which causes the vast majority of skin abscesses. […] For patients with signs of systemic toxicity, rapidly progressive or extensive erythema, or an inability to absorb oral therapy, intravenous therapy is warranted. […] Imaging or re-exploration of the wound is indicated for refractory infections to ensure that further drainage is not necessary. […] Other less common causes of refractory infection include resistant organisms, inadequate tissue penetration of antibiotics, and incorrect diagnosis. […] For patients with recurrent MRSA infection despite hygiene optimization or with ongoing transmission among close contacts, we suggest S. aureus decolonization.

• #64 Folliculitis and Skin Abscesses – Skin Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/skin-disorders/bacterial-skin-infections/folliculitis-and-skin-abscesses

  Folliculitis and skin abscesses are pus-filled pockets in the skin resulting from bacterial infection. They may be superficial or deep, affecting just hair follicles or deeper structures within the skin. […] Most skin abscesses are caused by Staphylococcus aureus bacteria and appear as pus-filled pockets on the skin surface. […] Doctors may try to eliminate Staphylococcus from people who are prone to repeat infections by instructing them to wash their entire body with antibacterial soap, apply antibiotic ointment inside the nose where the bacteria can hide, and take antibiotics by mouth. […] For severe, recurring folliculitis, doctors may take a bacterial culture (a sample of pus is sent to a laboratory and placed in a culture medium that allows microorganisms to grow). The results of the culture are used to guide the choice of antibiotic. Folliculitis is treated with antibacterial cleansers or antibiotics that are applied directly to the skin (topically). Large areas of folliculitis may require antibiotics taken by mouth.

• #65 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  Recurrences of skin abscesses are not uncommon, occurring in 7 to 14 percent of individuals within two months of completing therapy. […] Management of recurrent infections during the active stage of infection is the same as initial episodes. […] The mainstay of prevention includes attention to personal hygiene, decolonization, and consideration of the possibility of household or interpersonal transmission. […] There are little to no data to support the use of suppressive antibiotics to prevent recurrent skin abscesses. […] This topic discusses treatment of skin abscesses, including large furuncles and carbuncles. […] Fluctuant skin abscesses generally require incision and drainage to evacuate pus and necrotic debris. […] For all patients undergoing incision and drainage of a skin abscess, we suggest antibiotic therapy because it reduces the rate of treatment failure and recurrence. […] We feel most strongly about using antibiotics for those at highest risk.

• #66 Cellulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/214222-overview

  Treatment of recurrent disease (usually related to venous or lymphatic obstruction) is as follows: The cellulitis is most often due to Streptococcus species; daily amoxicillin or a macrolide may be effective for prevention of recurrences. […] If tinea pedis is suspected to be the predisposing cause, treat with topical or systemic antifungals. […] Compressive therapy has been shown to decrease risk for recurrence in patients with chronic edema and recurrent cellulitis. […] Patients with severe cellulitis require parenteral therapy, such as the following: Cefazolin, cefuroxime, ceftriaxone, nafcillin, or oxacillin for presumed staphylococcal or streptococcal infection. […] Clindamycin or vancomycin for penicillin-allergic patients. […] Broad gram-positive, gram-negative, and anaerobic coverage for cases associated with diabetic ulcers.

• #67 Evidence-based approach to abscess management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2231432/

  There are many areas of debate regarding abscess management, including pain control, necessity of culture and sensitivity testing, empiric treatment with antibiotics, and open versus primary closure of wounds. […] In immunocompetent patients with no confounding risk factors, incision and drainage under local anesthetic is generally sufficient for abscess management. There is no compelling evidence for routine cultures or empiric treatment with antibiotics. Further research is required. […] Incision and drainage (ID) is universally accepted as the treatment of choice for cutaneous abscesses. […] Most authors advocate surgical drainage of abscesses, and many cohort studies support this approach. […] Routine sampling for culture and sensitivity testing is debated in the literature. Evidence shows that routine cultures do not change management or outcome for patients presenting with abscesses.

• #68 Evidence-based approach to abscess management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2231432/

  Although it appears that antibiotics are commonly prescribed after ID, evidence suggests that there is no benefit to this practice and does not support using oral antibiotics after surgical drainage. […] Current research focuses primarily on immunocompetent patients without complications. Empiric antibiotic therapy might be considered for those who are immunocompromised or present with a large surrounding area of cellulitis, systemic toxicity, or lymphangitis. […] Primary closure following ID was first advocated in 1951. Many British trials have evaluated primary suture of the cavity following ID. […] At present, there is a lack of convincing evidence to support primary closure of abscesses, and using general anesthetic precludes its application in the office setting.

• #69 Skin and Soft Tissue Infections | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p474.html

  Skin and soft tissue infections result from microbial invasion of the skin and its supporting structures. Management is determined by the severity and location of the infection and by patient comorbidities. […] Initial antimicrobial choice is empiric, and in simple infections should cover Staphylococcus and Streptococcus species. Patients with complicated infections, including suspected necrotizing fasciitis and gangrene, require empiric polymicrobial antibiotic coverage, inpatient treatment, and surgical consultation for debridement. […] Superficial and small abscesses respond well to drainage and seldom require antibiotics. Immunocompromised patients require early treatment and antimicrobial coverage for possible atypical organisms. […] Uncomplicated purulent SSTIs in easily accessible areas without overlying cellulitis can be treated with incision and drainage only; antibiotic therapy does not improve outcomes.

• #70 Skin and Soft Tissue Infections | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p474.html

  Inpatient treatment is recommended for patients with uncontrolled SSTIs despite adequate oral antibiotic therapy; those who cannot tolerate oral antibiotics; those who require surgery; those with initial severe or complicated SSTIs; and those with underlying unstable comorbid illnesses or signs of systemic sepsis. […] Treatment of necrotizing fasciitis involves early recognition and surgical debridement of necrotic tissue, combined with high-dose broad-spectrum intravenous antibiotics. […] Mild purulent SSTIs in easily accessible areas without significant overlying cellulitis can be treated with incision and drainage alone. […] Antibiotic therapy is required for abscesses that are associated with extensive cellulitis, rapid progression, or poor response to initial drainage; that involve specific sites (e.g., face, hands, genitalia); and that occur in children and older adults or in those who have significant comorbid illness or immunosuppression.

• #71 Skin and Soft Tissue Infections | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p474.html

  Inpatient treatment is recommended for patients with uncontrolled SSTIs despite adequate oral antibiotic therapy; those who cannot tolerate oral antibiotics; those who require surgery; those with initial severe or complicated SSTIs; and those with underlying unstable comorbid illnesses or signs of systemic sepsis. […] Treatment of necrotizing fasciitis involves early recognition and surgical debridement of necrotic tissue, combined with high-dose broad-spectrum intravenous antibiotics. […] Mild purulent SSTIs in easily accessible areas without significant overlying cellulitis can be treated with incision and drainage alone. […] Antibiotic therapy is required for abscesses that are associated with extensive cellulitis, rapid progression, or poor response to initial drainage; that involve specific sites (e.g., face, hands, genitalia); and that occur in children and older adults or in those who have significant comorbid illness or immunosuppression.

• #72 Skin Abscess: Causes, Diagnosis, and Treatment

  https://www.healthline.com/health/skin-abscess

  After the procedure is over, your doctor will likely prescribe antibiotics to prevent the wound from becoming infected. […] Your doctor might prescribe an oral antibiotic depending on the appearance and symptoms of the abscess. The antibiotics that are typically prescribed in this instance include: clindamycin, cephalexin, dicloxacillin, doxycycline, trimethoprim-sulfamethoxazole (Bactrim). […] In some cases, an individual with comorbid conditions (which occur at the same time) or severe infection may require hospitalization and will be given antibiotics through their vein. […] After treatment, the abscess shouldn’t return.

• #73 Skin and Soft Tissue Infections | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p474.html

  In uncomplicated cellulitis, five days of treatment is as effective as 10 days. […] Inpatient treatment is necessary for patients who have uncontrolled infection despite adequate outpatient antimicrobial therapy or who cannot tolerate oral antibiotics. […] Broad-spectrum antibiotics with proven effectiveness against gram-positive and gram-negative organisms and anaerobes should be used until pathogen-specific sensitivities are available; coverage can then be narrowed. […] The recommended duration of antibiotic therapy for hospitalized patients is seven to 14 days. […] The antibiotic spectrum can be narrowed once the infecting microbes are identified and susceptibility testing results are available.

• #74 Skin and Soft Tissue Infections | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p474.html

  In uncomplicated cellulitis, five days of treatment is as effective as 10 days. […] Inpatient treatment is necessary for patients who have uncontrolled infection despite adequate outpatient antimicrobial therapy or who cannot tolerate oral antibiotics. […] Broad-spectrum antibiotics with proven effectiveness against gram-positive and gram-negative organisms and anaerobes should be used until pathogen-specific sensitivities are available; coverage can then be narrowed. […] The recommended duration of antibiotic therapy for hospitalized patients is seven to 14 days. […] The antibiotic spectrum can be narrowed once the infecting microbes are identified and susceptibility testing results are available.

• #75 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Recurrences of skin abscesses are not uncommon, occurring in 7 to 14 percent of individuals within two months of completing therapy. […] The mainstay of prevention includes attention to personal hygiene, decolonization, and consideration of the possibility of household or interpersonal transmission. […] For patients with recurrent MRSA infection despite hygiene optimization or with ongoing transmission among close contacts, we suggest S. aureus decolonization. […] This topic discusses treatment of skin abscesses, including large furuncles and carbuncles. […] Fluctuant skin abscesses generally require incision and drainage to evacuate pus and necrotic debris. […] For all patients undergoing incision and drainage of a skin abscess, we suggest antibiotic therapy because it reduces the rate of treatment failure and recurrence.

• #76 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  Recurrences of skin abscesses are not uncommon, occurring in 7 to 14 percent of individuals within two months of completing therapy. […] Management of recurrent infections during the active stage of infection is the same as initial episodes. […] The mainstay of prevention includes attention to personal hygiene, decolonization, and consideration of the possibility of household or interpersonal transmission. […] There are little to no data to support the use of suppressive antibiotics to prevent recurrent skin abscesses. […] This topic discusses treatment of skin abscesses, including large furuncles and carbuncles. […] Fluctuant skin abscesses generally require incision and drainage to evacuate pus and necrotic debris. […] For all patients undergoing incision and drainage of a skin abscess, we suggest antibiotic therapy because it reduces the rate of treatment failure and recurrence. […] We feel most strongly about using antibiotics for those at highest risk.

• #77 Cutaneous Abscess – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/cutaneous-abscess

  A cutaneous abscess is a localized collection of pus in the skin and may occur on any skin surface. […] Treatment is incision and drainage and sometimes antibiotics. […] Incision and drainage are indicated when significant pain, tenderness, and swelling are present; it is unnecessary to await fluctuance. […] Antibiotics have traditionally been considered unnecessary unless the patient has signs of systemic infection, cellulitis, multiple abscesses, immunocompromise, or a facial abscess in the area drained by the cavernous sinus. […] However, subsequent studies have suggested lower rates of treatment failure and recurrence when antibiotics are added for any abscess that requires treatment in locations where MRSA is prevalent. […] Drain abscesses accompanied by significant pain, tenderness, and swelling and provide adequate analgesia and, when indicated, sedation. […] Give antibiotics if the patient has signs of systemic infection, cellulitis, multiple abscesses, immunocompromise, or a facial abscess.

• #78 Skin abscess Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/skin-abscess

  A skin abscess is a buildup of pus in or on the skin. […] You can apply moist heat (such as warm compresses) to help the abscess drain and heal faster. Do not push and squeeze on the abscess. Your provider may cut open the abscess and drain it. If this is done: Numbing medicine will be put on or into your skin. Packing material may be left in the wound to help it heal. You may need to take antibiotics by mouth to control the infection. […] Most skin abscesses can be cured with proper treatment. Infections caused by MRSA respond to specific antibiotics.

• #79 Skin Abscess – UF Health

  https://ufhealth.org/conditions-and-treatments/skin-abscess

  A skin abscess is a buildup of pus in or on the skin. […] Skin abscesses may occur after developing a bacterial infection (often staphylococcus). […] You can apply moist heat (such as warm compresses) to help the abscess drain and heal faster. […] Your provider may cut open the abscess and drain it. […] You may need to take antibiotics by mouth to control the infection. […] Most skin abscesses can be cured with proper treatment. […] Infections caused by MRSA respond to specific antibiotics.

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