Recurrent abscesses since childhood (neutrophil disorder evaluation)
Follow-up planning
Wound check timing
48-72 hours for reassessment if packing placed (pack removal)
1-2 weeks if no packing used; sooner if worsening
Culture results review to guide antibiotic adjustment
Recurrence prevention planning at discharge
Decolonization protocol initiation
Household contact counseling
Treatment
Incision and drainage
I&D as primary treatment
Cornerstone of cutaneous abscess management (Class I recommendation)
Curative alone for most uncomplicated abscesses
Needle aspiration not recommended as definitive treatment (26% success vs 80% I&D)
Anesthesia for I&D
Local anesthesia
Lidocaine 1-2% with or without epinephrine (avoid epinephrine in digits, tip of nose, penis)
Field block around abscess margin preferred over intralesional injection into infected tissue
Maximum lidocaine dose 4.5 mg/kg without epinephrine; 7 mg/kg with epinephrine
Procedural sedation considerations
Large abscesses in sensitive areas (face, genitalia)
Pediatric patients
High-anxiety patients
I&D procedure steps
Incision along skin tension lines for optimal cosmesis
Incision length sufficient for complete drainage
Blunt dissection to break up loculations (hemostat)
Cavity irrigation with normal saline
Packing decision
Routine packing not recommended by current evidence
Packing increases pain without improving outcomes
Simple dry dressing preferred over routine packing
Culture collection from expressed pus recommended by IDSA
Loop drainage technique (alternative)
Two small stab incisions with vessel loop threaded through cavity
Preferred in pediatric patients
Less painful, avoids packing, comparable efficacy
Allows outpatient loop removal after 7-10 days
Adjunctive antibiotics
Antibiotic indications post-I&D
Mild, uncomplicated (no SIRS): no antibiotics required after I&D alone
Moderate (SIRS criteria present): oral antibiotics with MRSA activity for 7-10 days
Severe (SIRS + hypotension or immunocompromised): IV antibiotics
Evidence base: Daum et al. NEJM 2017 — TMP-SMX and clindamycin improved cure rates over placebo (81.7% and 83.1% vs 68.9%) when added to I&D for abscesses ≤ 5 cm
Preferred oral antibiotic: TMP-SMX
TMP-SMX DS (160/800 mg) 1-2 tablets PO BID x 7-10 days
Number needed to treat approximately 7-8 for one additional cure
Benefit persists at 4-week and 6-month follow-up
Greatest benefit in patients with surrounding cellulitis > 5 cm
Antibiotic stewardship considerations
Antibiotics not indicated for uncomplicated abscess with no SIRS after successful I&D
Overprescription of antibiotics contributes to resistance and C. difficile
Cephalexin inadequate for MRSA coverage; avoid as sole agent
Decolonization evidence
Intranasal mupirocin + chlorhexidine body wash reduces S. aureus nasal carriage
Household decolonization reduces recurrence in cluster outbreaks
Robinson et al., Clin Infect Dis 2025: evaluating personal and environmental decolonization strategies in children with SSTIs
Patient Discharge Instructions
copy discharge instructions
What is a skin abscess?
A skin abscess is a pocket of pus under the skin caused by a bacterial infection
The most common cause is Staphylococcus aureus, including MRSA (a resistant type)
Treatment involves draining the pus (incision and drainage) and sometimes antibiotics
Wound care after drainage
Keep the wound clean and dry; change dressings as instructed by your doctor
If a wick or packing was placed, follow instructions for removal (typically 48-72 hours)
Warm compresses may help with residual induration and discomfort
Do not squeeze or manipulate the wound
Antibiotic instructions (if prescribed)
Take antibiotics exactly as prescribed for the full course even if feeling better
Common side effects: nausea, diarrhea — take TMP-SMX with food and plenty of water
Contact us if severe diarrhea, rash, or allergic reaction develops
Expected recovery
Most uncomplicated abscesses heal within 1-2 weeks after adequate drainage
Some redness and tenderness is expected for several days
Return for wound check in 48-72 hours as instructed
Return to emergency department immediately if
Worsening redness, swelling, or pain despite treatment
Fever above 38°C (100.4°F) or chills
Red streaking spreading from the wound
Wound not improving or worsening after 48 hours of treatment
Feeling generally unwell, confused, or very weak
New drainage from the wound that looks different or smells bad
Prevent recurrence
Wash hands frequently with soap and water
Do not share towels, razors, or personal hygiene items
Wash bedding and towels in hot water regularly
If prescribed decolonization: apply mupirocin to both nostrils twice daily for 5 days
Use chlorhexidine body wash daily for 5-14 days as instructed
Household members may also need decolonization if abscess keeps coming back
Follow-up
Wound recheck: 48-72 hours from today if packing placed
Routine follow-up: 1-2 weeks if no packing used
If culture results are pending, your doctor will contact you about antibiotic adjustments
References
Guidelines and key sources
Primary guidelines
Stevens DL, Bisno AL, Chambers HF, et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the IDSA. Clinical Infectious Diseases. 2014. doi:10.1093/cid/ciu296
ACEP Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. American College of Emergency Physicians. 2023
Landmark trials
Singer AJ, Talan DA. Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus. NEJM. 2014. doi:10.1056/NEJMra1212788
Daum RS, Miller LG, Immergluck L, et al. A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses. NEJM. 2017. doi:10.1056/NEJMoa1607033
Systematic reviews and meta-analyses
Gottlieb M, Avila J, Chottiner M, Peksa GD. Point-of-Care Ultrasonography for the Diagnosis of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-Analysis. Annals of Emergency Medicine. 2020. PMID: 32081383
Long B, Gottlieb M. Diagnosis and Management of Cellulitis and Abscess in the Emergency Department Setting: An Evidence-Based Review. J Emerg Med. 2022. PMID: 34657784
Menegas S, Moayedi S, Torres M. Abscess Management: An Evidence-Based Review for Emergency Medicine Clinicians. J Emerg Med. 2021. PMID: 33298356
Additional references
Jeffers K, Keim SM, Long B, Gottlieb M, Adhikari SR. Point-of-Care Ultrasound for Diagnosis of Soft Tissue Abscess vs Cellulitis. J Emerg Med. 2025. PMID: 40274497
Robinson AL, Boyle MG, Hogan PG, et al. Evaluating Personal and Environmental Decolonization Strategies for Children With SSTI. Clin Infect Dis. 2025. PMID: 41276461
Jenkins TC, Knepper BC, Moore SJ, et al. Microbiology and Initial Antibiotic Therapy for Injection Drug Users and Non-Injection Drug Users With Cutaneous Abscesses. Acad Emerg Med. 2015. PMID: 26202847
Toschi A, Giannella M, Viale P. Recurrence of Skin and Soft Tissue Infections: Identifying Risk Factors and Treatment Strategies. Curr Opin Infect Dis. 2025. PMID: 39882704
Mersal M, Embaby O, Ayyad M, et al. Beyond the Knife: A Contemporary Review of Subcutaneous Abscesses. ANZ J Surg. 2025. PMID: 41420370
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.