New Abscess Management Pathways

Auckland Regional HealthPathways has developed three new 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 both 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.
2. POAC does not fund IV antibiotics for skin and soft tissue abscess management. 
3. Surrounding zone of redness usually settles in 24-48hrs. Trial oral antibiotics if not settling.

BARTHOLIN'S ABSCESS

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.

BREAST ABSCESS

1. POAC does not fund IV antibiotics in primary care for any patient with a breast abscess. 
2. If abscess diagnosed (clinically or on USS) refer to general surgery for surgical drainage.
3. Breast ultrasound 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 48hrs oral antibiotic therapy.