What are the recommended guidelines for the incision and drainage of a cutaneous abscess in primary care?

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 ¹.

• An appropriate interactive dressing should be used for surgical wounds healing by secondary intention ¹.
• A tissue viability nurse or another healthcare professional with tissue viability expertise should be consulted for advice on appropriate dressings ¹.
• Eusol and gauze, moist cotton gauze, mercuric antiseptic solutions, dextranomer, or enzymatic treatments should not be used for managing or debriding these wounds ¹.
• An aseptic non-touch technique must be used for changing or removing surgical wound dressings ¹.
• Sterile saline should be used for wound cleansing up to 48 hours after surgery ¹.
• Patients can be advised to shower safely 48 hours after surgery ¹.
• 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 ¹.

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 ¹.
• Samples of pus from a drained abscess should be sent to the microbiology laboratory to enable antibiotic treatment to be tailored to sensitivities ².
• When microbiological results are available, the choice of antibiotic should be reviewed and changed to a narrow-spectrum antibiotic if appropriate ³.
• 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 ³.
• 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 ³.

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 ².