Figure 5.

Recommended approach to the management of patients presenting with skin abscesses based on current evidence). Management of the acute infection includes incision and drainage, culture of the purulent material for organism identification and susceptibility testing, and systemic antibiotic therapy. Decolonization should be recommended for patients who experience recurrent skin abscesses or in settings of ongoing transmission (e.g., SSTI in multiple household members) despite optimizing hygiene measures. Specifically, the recommended decolonization regimen is a 5-day protocol consisting of intranasal application of mupirocin (approximately a pea-sized amount to each nostril, applied with a sterile cotton-tipped applicator) twice daily, and daily antimicrobial body washes with either chlorhexidine or dilute bleach water baths. Chlorhexidine should be applied with a clean washcloth to the neck and below (contact with the face and ears should be avoided as ocular and ototoxicity may occur) and should be rinsed off after 1–3 minutes. Dilute bleach baths should consist of ¼ cup of bleach per ¼ filled bathtub for a standard sized bathtub or 1 teaspoon of bleach per gallon of bathwater for a non-standard bathtub; individuals should soak in the dilute bleach water for 15 minutes.