Most of what we were taught about abscess management has been challenged by the evidence. Module 3 of The Abscess Course covers three of the biggest controversies. Here is the short version.
Packing. The literature is clear that small abscesses, those under 5 cm, do not need to be packed. Packing causes pain, requires repeat visits, and adds time without clear benefit. Reserve it for larger cavities, immunocompromised patients, and diabetics.
Irrigation. Routine saline irrigation of cutaneous abscesses does not improve outcomes. It hurts, makes a mess, and adds time. Skip it on the average abscess. Consider it only when the cavity is large and you cannot fully evacuate with manual expression.
Antibiotics. The old teaching was no antibiotics after I and D unless cellulitis was present. Recent evidence flipped that position. Oral antibiotics after drainage reduce recurrence and speed resolution. TMP-SMX or doxycycline, dosed to your local antibiogram, is the standard for community-acquired MRSA.
These three shifts will simplify your workflow and improve patient outcomes at the same time. The full evidence review is in Module 3.
View the full course at: https://www.ebmedicine.net/the-abscess-course
Sincerely,
Dr. Patrick O’Malley
The Abscess Course & The Laceration Course, Course Director
Patrick O’Malley is an emergency physician and course director of The Laceration Course and The Abscess Course. Follow him bellow for more…
