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Abscess I&D Without Antibiotics — SCE Infectious Diseases MCQ

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EasyInfection Prevention & ControlAbscess I&D Without AntibioticsSCE Infectious Diseases

A 55-year-old man with known MRSA colonisation develops a large (8 cm) subcutaneous abscess on his thigh. He is systemically well with no surrounding cellulitis. Temperature is 37.2°C. What is the primary management?

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Correct answer: B — Incision and drainage — for uncomplicated abscess without cellulitis or systemic features, I&D alone is the primary treatment; antibiotics are not routinely required

For uncomplicated skin abscesses without surrounding cellulitis, systemic features, or immunocompromise, incision and drainage alone is curative — antibiotics do NOT add benefit (multiple RCTs including the LOOP trial). This applies regardless of MRSA status. Wound packing may or may not be needed (evidence is equivocal). Antibiotics are indicated only if: surrounding cellulitis extends beyond the abscess margin, systemic signs (fever, tachycardia), immunocompromise, prosthetic material nearby, or high-risk location (face, hand, genitalia).

Reference: NICE NG141 2019 – SSTI; CREST 2005 – Abscess management; LOOP trial 2017