Table 1.
Current procedural guidelines for incision and drainage of simple cutaneous abscesses.
| Source | Pain management | I & D with cavity probing | Irrigation | Packing | Culture | Antibiotics |
|---|---|---|---|---|---|---|
| Roberts & Hedges4 | Local infiltration and systemic* | Yes | Mentions, but states no evidence exists for benefit | Gentle packing, mentions no evidence exists | Not discussed | Not discussed |
| Rosen’s Emergency Medicine5 | Local infiltration and systemic | Yes | Yes, no endpoint recommended | Gentle packing | Not recommended | Not recommended |
| Tintinalli’s Textbook of Emergency Medicine6 | Local infiltration, systemic, and mentions regional/field block | Yes | Yes, no endpoint recommended | Gentle packing | Not discussed | Advocates clinical judgment, generally not needed |
| Rakel Textbook of Family Medicine7 | Ring or field block, lack of effectiveness of local anesthesia mentioned | Yes | Yes, no endpoint recommended | Gentle packing | Routine culture in immunocompetent patients not recommended | Not recommended |
| UpToDate8 | Advocates local with field block/regional block | Yes | Yes, until all visible pus removed | Gentle packing for larger abscesses | Yes, for those receiving antibiotics | Discussed in separate article |
| NEJM9 | Local, mentions field/regional and systemic for comfort | Yes | Yes, until effluent is clear | Gentle packing | Optional | Based on community pathogens, generally not recommended |
| 2011 IDSA Guidelines10 | Not discussed | Yes | Not discussed | Not discussed | Useful in certain circumstances* | Recommended under certain circumstances† |
I&D, incision and drainage; NEJM, New England Journal of Medicine; IDSA, Infectious Diseases Society of America.
*
Patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, and patients who have not responded adequately to initial treatment, or concern for a cluster or outbreak.
†
Severe or extensive disease, rapid progression in presence of associated signs and symptoms of systemic illness–associated comorbidities or immunosuppression, extremes of age, abscess in an area difficult to drain (eg, face, hand, and genitalia), associated septic phlebitis, or lack of response to incision and drainage alone.