infectious diseases
Abscesses
Treatment of Abscesses
Surgical drainage or percutaneous needle aspiration Sometimes antibiotics Superficial abscesses may resolve with heat and oral antibiotics. However, healing usually requires drainage. Minor cutaneous abscesses may require only How To Incise and Drain an Abscess . All pus, necrotic tissue, and debris should be removed. With larger abscesses (eg, > 5 cm), eliminating open (dead) space by packing with gauze or by placing drains may be necessary to prevent reformation of the abscess. Predisposing conditions, such as obstruction of natural drainage or the presence of a foreign body, require correction. Deep abscesses can sometimes be adequately drained by percutaneous needle aspiration (typically guided by ultrasonography or CT); this method often avoids the need for open surgical drainage. Spontaneous rupture and drainage may occur, sometimes leading to the formation of chronic draining sinuses. Without drainage, an abscess occasionally resolves slowly after proteolytic digestion of the pus produces a thin, sterile fluid that is resorbed into the bloodstream. Incomplete resorption may leave a cystic loculation within a fibrous wall that may become calcified. Systemic antimicrobial drugs are not routinely given but are indicated as adjunctive therapy as follows: If the abscess is deep (eg, intra-abdominal) If abscesses are multiple If there is significant surrounding cellulitis Perhaps if size is > 2 cm Antimicrobial drugs are usually ineffective without drainage. Empiric antimicrobial therapy is based on location and likely infecting pathogen. Gram stain, culture, and susceptibility results guide further antimicrobial therapy. 