Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
The provided UK guidelines do not offer specific recommendations for the *procedure* of performing incision and drainage of a cutaneous abscess in primary care.
However, they do provide guidance on the **post-operative management of surgical wounds healing by secondary intention**, which would apply after an abscess drainage NICE NG125.
- An appropriate interactive dressing should be used for surgical wounds healing by secondary intention NICE NG125.
- A tissue viability nurse or another healthcare professional with tissue viability expertise should be consulted for advice on appropriate dressings NICE NG125.
- Eusol and gauze, moist cotton gauze, mercuric antiseptic solutions, dextranomer, or enzymatic treatments should not be used for managing or debriding these wounds NICE NG125.
- An aseptic non-touch technique must be used for changing or removing surgical wound dressings NICE NG125.
- Sterile saline should be used for wound cleansing up to 48 hours after surgery NICE NG125.
- Patients can be advised to shower safely 48 hours after surgery NICE NG125.
- After 48 hours, tap water can be used for wound cleansing if the surgical wound has separated or has been surgically opened to drain pus NICE NG125.
Regarding **antibiotic management**:
- If a surgical site infection is suspected, for example by the presence of cellulitis, an antibiotic covering the likely causative organisms should be given, considering local resistance patterns and microbiological test results NICE NG125.
- Samples of pus from a drained abscess should be sent to the microbiology laboratory to enable antibiotic treatment to be tailored to sensitivities NICE NG147.
- When microbiological results are available, the choice of antibiotic should be reviewed and changed to a narrow-spectrum antibiotic if appropriate NICE NG19.
- Patients should be advised about possible adverse effects of antibiotics and to seek medical help if symptoms worsen rapidly or significantly, or do not start to improve within 1 to 2 days NICE NG19.
- Reassessment is necessary if symptoms worsen rapidly or significantly, do not improve within 1 to 2 days, or if the person becomes systemically unwell or experiences severe pain disproportionate to the infection NICE NG19.
It is important to note that guidelines for diverticular abscesses, which are typically internal, recommend considering percutaneous drainage or surgery for abscesses greater than 3 cm, and switching to oral antibiotics for those less than 3 cm, which differs from the management of cutaneous abscesses NICE NG147.