Editing Abscess (section)

==Treatment==
The standard treatment for an uncomplicated skin or soft tissue abscess is the act of opening and draining.<ref name="ACEPfive"/> There does not appear to be any benefit from also using [[antibiotic]]s in most cases.<ref name=NEJM2014/> A small amount of evidence did not find a benefit from packing the abscess with gauze.<ref name=NEJM2014/>

===Incision and drainage===
{{Main|Incision and drainage}}
[[Image:Cleaned abscess day 5.jpg|thumb|right|Abscess five days after incision and drainage]]
[[File:HumeralAbscess.jpg|thumb|Abscess following [[curettage]]]]
The abscess should be inspected to identify if foreign objects are a cause, which may require their removal. If foreign objects are not the cause, incising and draining the abscess is standard treatment.<ref name="ACEPfive"/><ref>{{cite book |title=Surgery: Facts and Figures | vauthors = Green J, Wajed S |year=2000 |publisher=Cambridge University Press |isbn= 978-1-900151-96-2}}</ref>

=== Antibiotics ===
Most people who have an uncomplicated skin abscess should not use antibiotics.<ref name="ACEPfive"/> Antibiotics in addition to standard incision and drainage is recommended in persons with severe abscesses, many sites of infection, rapid disease progression, the presence of [[cellulitis]], symptoms indicating bacterial illness throughout the body, or a health condition causing [[immunosuppression]].<ref name=NEJM2014/> People who are very young or very old may also need antibiotics.<ref name=NEJM2014/> If the abscess does not heal only with incision and drainage, or if the abscess is in a place that is difficult to drain such as the face, hands, or genitals, then antibiotics may be indicated.<ref name=NEJM2014/>

In those cases of abscess which do require antibiotic treatment, ''[[Staphylococcus aureus]]'' bacteria is a common cause and an anti-staphylococcus antibiotic such as [[flucloxacillin]] or [[dicloxacillin]] is used. The [[Infectious Diseases Society of America]] advises that the draining of an abscess is not enough to address community-acquired [[Methicillin-resistant Staphylococcus aureus|methicillin-resistant ''Staphylococcus aureus'']] (MRSA), and in those cases, traditional antibiotics may be ineffective.<ref name=NEJM2014/> Alternative antibiotics effective against community-acquired MRSA often include [[clindamycin]], [[doxycycline]], [[minocycline]], and [[trimethoprim-sulfamethoxazole]].<ref name=NEJM2014/> The [[American College of Emergency Physicians]] advises that typical cases of abscess from MRSA get no benefit from having antibiotic treatment in addition to the standard treatment.<ref name="ACEPfive"/>

[[Cell culture|Culturing the wound]] is not needed if standard follow-up care can be provided after the incision and drainage.<ref name="ACEPfive"/> Performing a wound culture is unnecessary because it rarely gives information which can be used to guide treatment.<ref name="ACEPfive"/>

===Packing===
In North America, after drainage, an abscess cavity is usually packed, often with special iodoform-treated cloth. This is done to absorb and neutralize any remaining exudate as well as to promote draining and prevent premature closure. Prolonged draining is thought to promote healing. The hypothesis is that though the heart's pumping action can deliver immune and regenerative cells to the edge of an injury, an abscess is by definition a void in which no blood vessels are present. Packing is thought to provide a wicking action that continuously draws beneficial factors and cells from the body into the void that must be healed. Discharge is then absorbed by cutaneous bandages and further wicking promoted by changing these bandages regularly. However, evidence from emergency medicine literature reports that packing wounds after draining, especially smaller wounds, causes pain to the person and does not decrease the rate of recurrence, nor bring faster healing, or fewer physician visits.<ref>{{cite journal | vauthors = Bergstrom KG | title = News, views, and reviews. Less may be more for MRSA: the latest on antibiotics, the utility of packing an abscess, and decolonization strategies | journal = Journal of Drugs in Dermatology | volume = 13 | issue = 1 | pages = 89–92 | date = January 2014 | pmid = 24385125 }}</ref>

===Loop drainage===
More recently, several North American hospitals have opted for less-invasive loop drainage over standard drainage and wound packing. In one study of 143 pediatric outcomes, a failure rate of 1.4% was reported in the loop group versus 10.5% in the packing group (P<.030),<ref>{{cite journal | vauthors = Ladde JG, Baker S, Rodgers CN, Papa L | title = The LOOP technique: a novel incision and drainage technique in the treatment of skin abscesses in a pediatric ED | journal = The American Journal of Emergency Medicine | volume = 33 | issue = 2 | pages = 271–276 | date = February 2015 | pmid = 25435407 | doi = 10.1016/j.ajem.2014.10.014 }}</ref> while a separate study reported a 5.5% failure rate among the loop group.<ref>{{cite journal | vauthors = Tsoraides SS, Pearl RH, Stanfill AB, Wallace LJ, Vegunta RK | title = Incision and loop drainage: a minimally invasive technique for subcutaneous abscess management in children | journal = Journal of Pediatric Surgery | volume = 45 | issue = 3 | pages = 606–609 | date = March 2010 | pmid = 20223328 | doi = 10.1016/j.jpedsurg.2009.06.013 }}</ref>

===Primary closure===
Closing an abscess immediately after draining it appears to speed healing without increasing the risk of recurrence.<ref name=Singer2011/> This may not apply to anorectal abscesses as while they may heal faster, there may be a higher rate of recurrence than those left open.<ref name="pmid6397949">{{cite journal | vauthors = Kronborg O, Olsen H | title = Incision and drainage v. incision, curettage and suture under antibiotic cover in anorectal abscess. A randomized study with 3-year follow-up | journal = Acta Chirurgica Scandinavica | volume = 150 | issue = 8 | pages = 689–692 | year = 1984 | pmid = 6397949 }}</ref>

=== Appendiceal abscess ===
Appendiceal abscess are complications of appendicitis where there is an infected mass on the appendix. This condition is estimated to occur in 2–10% of appendicitis cases and is usually treated by surgical removal of the appendix (appendicectomy).<ref>{{Cite journal |last=Cheng |first=Yao |last2=Xiong |first2=Xianze |last3=Lu |first3=Jiong |last4=Wu |first4=Sijia |last5=Zhou |first5=Rongxing |last6=Cheng |first6=Nansheng |date=2017-06-02 |title=Early versus delayed appendicectomy for appendiceal phlegmon or abscess |url=https://pubmed.ncbi.nlm.nih.gov/28574593 |journal=The Cochrane Database of Systematic Reviews |volume=6 |issue=6 |pages=CD011670 |doi=10.1002/14651858.CD011670.pub2 |issn=1469-493X |pmc=6481778 |pmid=28574593}}</ref>