Treatment of Small Skin Abscesses

Primary Treatment Approach

Incision and drainage (I&D) is the cornerstone of treatment for small skin abscesses and is considered sufficient therapy for most uncomplicated cases 1, 2, 3
For very small furuncles (boils), application of moist heat may help promote spontaneous drainage and could be sufficient for resolution 3
Simply covering the surgical site with a dry dressing is usually adequate for post-procedure wound care 3

Antibiotics should be added to I&D in the presence of systemic inflammatory response syndrome (SIRS): temperature >38°C or <36°C, tachypnea >24 breaths/minute, tachycardia >90 beats/minute, or abnormal white blood cell count 1, 2
Markedly impaired host defenses or immunocompromised patients should be considered for antibiotics 1, 3
Significant surrounding cellulitis extending beyond the abscess borders may require antibiotics 4, 5
Incomplete source control after drainage may require antibiotics 5
High-risk locations (face, hands, genitalia) may require antibiotics 6

If MRSA is suspected or prevalent in the community, appropriate options include Trimethoprim-sulfamethoxazole (TMP-SMX) 6, Clindamycin 6, Doxycycline or minocycline (not for children <8 years) 6, and Linezolid (typically reserved for more severe cases) 6
For non-MRSA infections where streptococci are suspected, Beta-lactams (penicillinase-resistant penicillins or first-generation cephalosporins) may be used 3, 6
Duration of therapy is typically 5-10 days when antibiotics are indicated 1, 6

Recurrent abscesses require additional management, including searching for local causes, culturing and draining early in the course of infection, and considering a 5-day decolonization regimen with intranasal mupirocin, daily chlorhexidine washes, and decontamination of personal items for recurrent S. aureus infections 1
Cultures are not routinely needed for typical small abscesses but should be obtained in recurrent infections 1, treatment failures 6, patients with immunocompromise 4, and severe or atypical presentations 6

Failing to perform adequate I&D (the most important therapeutic intervention) 1, 3
Not considering MRSA coverage when antibiotics are indicated in areas with high MRSA prevalence 6
Overlooking underlying conditions that may predispose to recurrent abscesses 1