Management of Skin Abscesses

Evaluation and Diagnosis

The American College of Physicians recommends determining if a lesion is a simple abscess or a more complex infection, with simple abscesses having limited induration and erythema, and complex infections having erythema that extends more than 5 cm beyond the margins of the abscess, systemic signs, or significant immunocompromise 1, 4
The Infectious Diseases Society of America suggests that abscesses with erythema extending more than 5 cm beyond the margins, or with systemic signs, or in immunocompromised patients, require more complex management 1, 4

The Infectious Diseases Society of America recommends incision and drainage as the primary treatment for simple abscesses, with antibiotics only indicated if there are systemic signs of infection or erythema extending more than 5 cm beyond the margins of the abscess 1, 2, 3
The American College of Emergency Physicians suggests that drainage alone is sufficient for simple cutaneous abscesses, with little to no benefit from antibiotics when combined with adequate drainage 2

The Infectious Diseases Society of America recommends adding antibiotics if the patient has a temperature greater than 38.5°C, heart rate greater than 110 beats per minute, erythema extending more than 5 cm beyond the margins of the abscess, or signs of SIRS (Systemic Inflammatory Response Syndrome) 1, 3
The Society for Healthcare Epidemiology of America suggests that antibiotics should be considered in patients with significant immunocompromise or incomplete source control after drainage 3, 4

The Infectious Diseases Society of America recommends dicloxacillin 500 mg orally four times a day as the first-line agent for uncomplicated infections, with alternatives including cefalexin and clindamycin 5, 2, 3
For suspected MRSA, the American College of Physicians suggests using trimethoprim-sulfamethoxazole, doxycycline, or clindamycin, with vancomycin reserved for severe infections requiring parenteral therapy 5, 3

The Infectious Diseases Society of America recommends mupirocin ointment 2% applied to lesions three times a day for 8-12 days for limited lesions of impetigo or superficial infections, with an efficacy of 71-93% in controlled studies 5

The American College of Emergency Physicians advises against prescribing antibiotics without performing incision and drainage when indicated, as drainage is the primary treatment, not antibiotics 1, 2, 3
The Infectious Diseases Society of America suggests avoiding the prescription of antibiotics for all infected abscesses regardless of systemic symptoms, as most do not require them 1, 2, 4