Cut, Drain & Give some Antibiotics

Antibiotics after I&D lead to significantly better outcomes with significantly fewer antibiotic-treated participants having clinical failure requiring a new antibiotic or another drainage procedure. New abscesses may develop in 10.1 percent of the antibiotic group compared to 19.1 percent of the placebo group.



Evidence Based Abscess Management


Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus

Adam J. Singer, M.D., and David A. Talan, M.D.

N Engl J Med 2014; 370:1039-1047

The authors of this article summarize the literature thusly:

  1. Incision & drainage is definitive treatment. Non-complicated disease does not require additional antibiotic treatment, although the evidence is not strong.
  2. Packing of abscesses is a matter of tradition, and evidence is neither sufficient to conclusively confirm nor refute this practice.
  3. Primary closure of abscesses after I&D is reasonable, particularly for larger, exposed, and cosmetically important areas.
  4. Antibiotic coverage for primarily cellulitic soft-tissue infections ideally includes streptococcal coverage
  5. Wound cultures are not necessary.