Auckland Regional HealthPathways has developed three pathways for abscess management:

• Skin and soft tissue abscess in adults

• Bartholin's cyst or abscess 

• Mastitis and breast abscess

These best practice regionally agreed pathways have been developed with primary and secondary clinicians and signed off through the regional Clinical Pathways Operational Group. 

Please note the following main points:

SKIN OR SOFT TISSUE ABSCESS

1. 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.

2. Ultrasound scan under POAC is not funded

3. POAC does not fund IV antibiotics for skin and soft tissue abscess management. 

4. The surrounding zone of redness usually settles in 24-48hrs. Trial oral antibiotics if not settling.

BREAST ABSCESS/MASTITIS

1. POAC does not routinely fund IV antibiotics in primary care for any patient with a breast abscess (unless specifically discussed and advised by on-call surgical team)

2. If abscess is diagnosed (clinically or on USS) refer direct to general surgery for surgical drainage.

3. 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 (no POAC funding)

1. Do not perform simple incision and drainage.  If non-draining and severe pain, refer acutely to gynaecology for word catheter or marsupialisation.

2. If spontaneously draining, manage with simple analgesia and Sitz baths.

3. If non-draining and pain manageable manage with oral antibiotics.

4. No POAC funding or interventions apply 

Refer to the relevant HealthPathway links at the top of this page to confirm support management and appropriateness for POAC-funded incision and drainage of an abscess.

POAC will fund:

• Incision and Drainage (I&D)*

• Wound management post I&D * 

• GP review as clinically indicated * 

• Admin fee $15.50 (one per case)

• Breast ultrasound for bacterial mastitis (contact POAC to arrange scan at a specliast breast USS provider, only where failed 48 hours oral ab therapy)

• *Funding will cover a total maximum period of seven days treatment (after which time patient is required to self-fund)

• Full clinical notes must be provided, supporting treatment that is claimed

• POAC does not fund IV ABs for abscess unless specified by on-call surgical team

NB: Injury-related wounds should be referred under ACC and are not funded by POAC.