Treatment of Flank Abscesses

Primary Treatment: Source Control

The World Journal of Emergency Surgery recommends percutaneous drainage combined with antibiotic therapy for 4 days as the preferred approach for large abscesses in immunocompetent, non-critically ill patients 1
The American College of Surgeons suggests that surgical drainage should be considered when percutaneous drainage is not feasible or available, particularly in critically ill or immunocompromised patients 1
If percutaneous drainage is not feasible in immunocompetent, non-critically ill patients, antibiotics alone could be considered as primary treatment, according to the World Journal of Emergency Surgery 1
However, in critically ill or immunocompromised patients without drainage availability, surgical intervention should be the primary treatment, as recommended by the World Journal of Emergency Surgery 1

The World Journal of Emergency Surgery recommends Piperacillin/tazobactam 6 g/0.75 g loading dose, then 4 g/0.5 g q6h or 16 g/2 g by continuous infusion for immunocompetent, non-critically ill patients with adequate source control 1
The Infectious Diseases Society of America suggests that for critically ill or immunocompromised patients, Piperacillin/tazobactam or Eravacycline 1 mg/kg q12h should be used, with consideration of broader coverage including vancomycin or daptomycin for MRSA, third-generation cephalosporin for Gram-negatives, and metronidazole for anaerobes 1, 3
The World Journal of Emergency Surgery recommends that for patients with inadequate/delayed source control or high risk of ESBL-producing Enterobacterales, Ertapenem 1 g q24h or Eravacycline 1 mg/kg q12h should be used 1
For patients with septic shock, the World Journal of Emergency Surgery suggests Meropenem 1 g q6h by extended infusion or continuous infusion, OR Doripenem 500 mg q8h by extended infusion or continuous infusion, OR Imipenem/cilastatin 500 mg q6h by extended infusion, OR Eravacycline 1 mg/kg q12h 1
For documented beta-lactam allergy, the World Journal of Emergency Surgery recommends Eravacycline 1 mg/kg q12h or Tigecycline 100 mg loading dose then 50 mg q12h 1

The World Journal of Emergency Surgery recommends 4 days of antibiotic therapy in immunocompetent, non-critically ill patients if source control is adequate 1
The Infectious Diseases Society of America suggests that for immunocompromised or critically ill patients, antibiotic therapy should be continued for up to 7 days based on clinical conditions and inflammation indices if source control is adequate 1
The World Journal of Emergency Surgery recommends that for complex cases or inadequate drainage, antibiotic therapy should be continued for 2-6 weeks 3

The World Journal of Emergency Surgery warns that delayed surgical intervention worsens outcomes, and control of sepsis should be balanced with avoiding prolonged delay that increases complication risk 2
The American College of Surgeons advises that needle aspiration should not be attempted as it has low success rates, and failure to obtain cultures before initiating antibiotics limits the ability to tailor therapy 2, 3
The World Journal of Emergency Surgery recommends that persistent fever, bacteremia, or failure to improve indicates inadequate source control requiring repeat imaging and potential reoperation 2