Abscesses are walled off collections of pus in soft tissue, with Staphylococcus aureus (both sensitive and resistant to methicillin) being the microbe most frequently involved. Most uncomplicated abscesses should undergo incision in an acute care setting such as the emergency department, using local anesthesia or procedural sedation, with complete drainage and appropriate follow-up. Antibiotics may be considered when patients are immunocompromised, systemically ill, or exhibit extensive surrounding cellulitis or lymphangitis. In populations with a high [methicillin-resistant S. aureus] MRSA prevalence, there is some evidence to suggest that antibiotics in addition to incision and drainage of uncomplicated abscesses may confer some benefit. However, we encourage physicians to discuss the use of antibiotics in uncomplicated abscesses with patients as the benefits conferred by antibiotics may not outweigh the risks associated with their use (i.e. nausea, diarrhea, and allergic reactions).
Sources:
Daum RS, et al. A placebo-controlled trial of antibiotics for smaller skin abscesses. N Engl J of Med. 2017; 376(26):2545-2555. PMID:28657870.
Talan DA, et al. Trimethoprim-Sulfamethoxazole versus placebo for uncomplicated skin abcess. N Engl J Med. 2016; 374(9):823-32. PMID:26962903.
Vermandere, M, et al. Antibiotics after incision and drainage for uncomplicated skin abcesses: a clinical practice guideline. BMJ. 2018; 360:k243. PMID: 29437651.
Related Resources:
Patient Pamphlet: Avoid Unnecessary Treatments in the ED: Talking with the doctor can help you make the best decision