Treatment of Skin Abscesses: A Review of Wound Packing and Post-Procedural Antibiotics

Skin abscesses can be a significant source of morbidity and are frequently encountered by physicians across the country. Incision and drainage (I&D) remains the standard of care; however, significant variability exists in the treatment of abscesses after I&D. Some recent evidence has suggested that routinely performed treatment modalities may not be beneficial. We examine the available evidence investigating if I&D alone is sufficient as the sole management for the treatment of uncomplicated abscesses, specifically focusing on wound packing and post-procedural antibiotics.

We reviewed available literature for any published observational or randomized control trials on the treatment of abscesses via packing and antibiotics. Only recent manuscripts published in the English language and in the past 10 years (2004 through 2014) were included due to the emergence of methicillin-resistant Staphylococcus aureus (MRSA) as one of the leading causative organism of soft tissue infections in the past decade.

Three randomized control trials (RCT) and one observational study investigated wound packing versus no packing following I&D. None of the studies demonstrated a difference in treatment failure rates, recurrence rates, or need for secondary interventions in non-packed wounds; however, packing groups had more pain. Six studies investigated the post-procedural use of antibiotics. The RCTs failed to show decreases in treatment failure rates with antibiotics, but two studies demonstrated a short-term decrease in new lesion formation. The observational studies demonstrated mixed results regarding rates of treatment cure with appropriate antibiotic selection, specifically in patients with positive wound cultures for MRSA.

Regardless of supplemental post-procedural treatment, all studies demonstrate high rates of clinical cure following I&D. While the number of studies is small, there is data to support the elimination of abscess packing and routine avoidance of antibiotics post-I&D in an immunocompetent patient; however, antibiotics should be considered in the presence of high risk features. Due to limited studies and conflicting data, we are unable to make a recommendation in support or opposition of adjunctive post-procedural packing and antibiotics in an immunocompromised patient.