Abscess Management Pathways
Auckland Regional HealthPathways has developed three pathways for abscess management:
The below best practice, regionally agreed-upon pathways have been developed with primary and secondary clinicians and signed off through the regional Clinical Pathways Operational Group.
POAC Funding
POAC will fund abscess management in accordance with the Auckland Regional HealthPathways, as detailed below. These pathways represent regionally agreed best practice, developed in collaboration between primary and secondary care clinicians and specialists.
POAC funding includes:
Incision and Drainage (I&D) - for significant I&D procedures only (not simple needle punctures)
Wound management post I&D
GP review as clinically indicated
Funding will cover a total maximum period of seven days of treatment (after which time the patient is required to self-fund)
POAC will fund a soft tissue ultrasound under the following conditions:
Breast ultrasound for bacterial mastitis to rule out collection is funded through POAC when there is no presumptive diagnosis of breast abscess, but the breast remains enlarged, reddened, and painful following 48 hours of oral antibiotic therapy.
To confirm soft tissue abscess is present and identify its location and depth for drainage (no trial oral antibiotics required)
Important notes:
POAC does not fund IV ABs for abscess
Injury-related wounds should be referred under ACC and are not funded by POAC.
Full clinical notes must be provided, supporting treatment that is claimed
Skin and Soft Tissue Abscess in Adults
Management of a skin or soft tissue abscess is to incise and drain the pus. Consider referral to POAC for funding of incision and drainage if performing the procedure in primary care avoids same‑day unplanned hospital attendance.
Ultrasound scan under POAC is not funded
POAC does not fund IV antibiotics for skin and soft tissue abscess management.
The surrounding zone of redness usually settles in 24-48hrs. Trial oral antibiotics if not settling.
Breast Abscess and Mastitis
POAC does not fund IV antibiotics in primary care for any patient with a breast abscess.
If an abscess is diagnosed (clinically or on USS), refer direct to general surgery for surgical drainage.
Breast ultrasound for bacterial mastitis to rule out collection is funded through POAC when there is no presumptive diagnosis of breast abscess, but the breast remains enlarged, reddened, and painful following 48 hours of oral antibiotic therapy.
Note: There is no need to routinely arrange a breast ultrasound for a clinically obvious breast abscess or suspected galactocele before referring in for further investigation, aspiration, or drainage.
Bartholin's Abscess (not POAC funded)
Do not perform simple incision and drainage. If non-draining and severe pain, refer acutely to gynaecology.
If spontaneously draining, manage with simple analgesia and Sitz baths.
If non-draining and pain manageable, manage with oral antibiotics.
No POAC funding or interventions apply