Treatment of Skin Abscesses in Pediatric Patients

Initial Management

Incision and drainage is the primary treatment for skin abscesses, followed by antibiotics active against MRSA due to the presence of fever and systemic symptoms, as recommended by the Infectious Diseases Society of America 1, 2
The presence of fever, irritability, and a large abscess with fluctuance indicates the need for systemic antibiotics in addition to incision and drainage, with a strength of evidence level of moderate 2, 4
Blood cultures are recommended due to the presence of systemic inflammatory response syndrome with high fever, as suggested by the Clinical Infectious Diseases guidelines 4, 3
Culture of the abscess drainage is essential to guide targeted antibiotic therapy, with a high level of evidence supporting this practice 2, 3

An antibiotic active against MRSA is recommended due to the presence of systemic inflammatory response syndrome and fluctuant abscess with purulent center, with a strength of evidence level of high 2, 3
Appropriate empiric antibiotic options include clindamycin and trimethoprim-sulfamethoxazole, as recommended by the Clinical Infectious Diseases guidelines 4

5-10 days of antibiotic therapy is recommended based on clinical response, with a moderate level of evidence supporting this duration 4, 3
Treatment should be extended if the infection has not improved within 5 days, as suggested by the Clinical Infectious Diseases guidelines 4, 3

Re-evaluation within 48-72 hours to assess response to treatment is recommended, with a high level of evidence supporting this practice 1, 4
Adjust antibiotics based on culture results and clinical response, as recommended by the Infectious Diseases Society of America 2, 3

Failure to perform incision and drainage is a common pitfall, as I&D is essential for abscess treatment and antibiotics alone are insufficient, with a high level of evidence supporting this practice 1, 2
Inadequate drainage can lead to treatment failure, and ensuring complete evacuation of purulent material is crucial, as recommended by the Clinical Infectious Diseases guidelines 2, 3
Insufficient duration of treatment can lead to recurrence, and continuing antibiotics until clinical improvement is evident is essential, with a moderate level of evidence supporting this practice 4, 3