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So, will an antibiotic work, or should this abscess be lanced?

Numerous times I have seen so many people report to the Emergency room for abscesses and skin infections. The first question usually asked is, "Will antibiotics work or should this be lanced?"To answer this question and to save you time, money, and even a little additional pain from undergoing a premature I and D, this blog was created.

Sometimes an abscess may not be amendable to drainage on the initial presentation. Premature incision into an abscess before it is well localized or fluctuant may actually allow the harmful spread of infection into adjacent and deeper tissues. In these situations, it is appropriate to treat with antibiotics for 24 to 48 hours while the abscess "ripens", along with the help of warm compresses. Resolution of the lesion during this time implies that the pathologic process was cellulitis and not an abscess and thus would not have required incision and drainage at all. In the immunocompromised, Diabetics, patients with artificial heart valves or joints, it is also recommended to initiate empiric antibiotics before considering I & D. Fluctuant abscesses, those in which are obviously fluid filled, or abscesses that do not resolve despite conservative measures and are larger than 5mm, drainage is indicated.

Most patients often have concerns as to what type of bacterial infection that they have, and often inquire as to whether it was Staph/ MRSA. It is no longer recommended procedure to obtain cultures during an I and D. As the two most common microorganisms leading to abscess formation are Staphylococcus and Streptococcus.

Local measures , such as meticulous handwashing, no sharing of towels, clothing, and personal hygiene products; avoiding loofas or sponges in the bath or shower; changing undergarments, sleepwear, towels, and washcloths daily; aggressive scrubbing of showers, bathrooms and surfaces with bleach; bleach baths (1/4-1/2 cup per 20 liters of bathwater for 15 minutes three to five times weekly), 4% chlorhexadine washes, and isolation of infected patients who reside in institutions to prevent spread are all effective measures of prevention.

I hope that this blog answers many of your questions about abscesses. Melissa D. Roberts, PA-C / Urgent Virtual Clinic/ Urgentvirtualclinic.com



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