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cesses
Abscesses
A n abscess is a co llectio n o f p us in the so ft tissues m o st co m m o nly d ue to Staphylococcus
aureus.
D uring th e sup p urative stage, a „rip e‟ abscess is red , inflam ed , p ainful, sh iny and
swo llen. It is usually fluctuant o n p alp atio n and m ay be fistulated . A t this stage, the
abscess cavity is inaccessible to antibio tics and surgical d rainage is the o nly effective
treatm ent.
D uring th e early ind urated stage, th at p reced es th e sup p urative stage m ed ical
treatm ent m ay be effective.
Treatment
Medical treatment (ind urated stage)
• A ntibio tic therap y :
C hild ren: amoxicillin P O : 8 0 m g/ k g/ d ay in 3 d ivid ed d o ses
+ metronidazole P O : 3 0 to 5 0 m g/ k g/ d ay in 3 d ivid ed d o ses
A d ults: amoxicillin P O : 3 0 0 0 m g/ d ay in 3 d ivid ed d o ses
+ metronidazole P O : 1 5 0 0 m g/ d ay in 3 d ivid ed d o ses
or
amoxicilline/ clavulanic acid (co-amoxiclav) P O , o nly if fo rm ulatio ns in a ratio 8 :1 o r 7 :1
are available. T he d o se is exp ressed in am o xicillin:
C hild ren < 4 0 k g: 8 0 m g/ k g/ d ay in 2 to 3 d ivid ed d o ses
C hild ren ≥ 4 0 k g and ad ults: 2 5 0 0 to 3 0 0 0 m g/ d ay in 3 d ivid ed d o ses d ep end ing
on
fo rm ulatio n available:
- ratio 8 :1 : 3 0 0 0 m g/ d ay = 2 tablets o f 5 0 0 / 6 2 .5 m g, 3 tim es/ d ay
- ratio 7 :1 : 2 6 2 5 m g/ d ay = 1 tablet o f 8 7 5 / 1 2 5 m g, 3 tim es/ d ay
• A d ap t analgesics to the p ain level (see Pain, p age 2 9 ).
• A p p ly co m p resses so ak ed in 7 0 % alco ho l, 2 tim es/ d ay (m axim um 3 tim es/ d ay
to
p revent burns to the sk in).
I f th ere is im p ro vem ent after 4 8 h o urs: co ntinue antibio tic treatm ent fo r 5 d ay s to
co m p lete 7 d ay s o f treatm ent.
I f there is no im p ro vem ent after 4 8 ho urs o f co rrect treatm ent: treat surgically .
Surgical drainage (sup p urative stage)
Material
– S terile scalp el hand le and blad e
– S terile curved , no n-to o thed artery fo rcep s (Kelly ty p e)
– S terile glo ves
– A ntisep tic
– 5 o r 1 0 m l sy ringe
– N o n-abso rbable sutures
– S terile co rrugated d rain
274
Abscesses
A n abscess is a co llectio n o f p us in the so ft tissues m o st co m m o nly d ue to Staphylococcus
aureus.
D uring th e sup p urative stage, a „rip e‟ abscess is red , inflam ed , p ainful, sh iny and
swo llen. It is usually fluctuant o n p alp atio n and m ay be fistulated . A t this stage, the
abscess cavity is inaccessible to antibio tics and surgical d rainage is the o nly effective
treatm ent.
D uring th e early ind urated stage, th at p reced es th e sup p urative stage m ed ical
treatm ent m ay be effective.
Treatment
Medical treatment (ind urated stage)
• A ntibio tic therap y :
C hild ren: amoxicillin P O : 8 0 m g/ k g/ d ay in 3 d ivid ed d o ses
+ metronidazole P O : 3 0 to 5 0 m g/ k g/ d ay in 3 d ivid ed d o ses
A d ults: amoxicillin P O : 3 0 0 0 m g/ d ay in 3 d ivid ed d o ses
+ metronidazole P O : 1 5 0 0 m g/ d ay in 3 d ivid ed d o ses
or
amoxicilline/ clavulanic acid (co-amoxiclav) P O , o nly if fo rm ulatio ns in a ratio 8 :1 o r 7 :1
are available. T he d o se is exp ressed in am o xicillin:
C hild ren < 4 0 k g: 8 0 m g/ k g/ d ay in 2 to 3 d ivid ed d o ses
C hild ren ≥ 4 0 k g and ad ults: 2 5 0 0 to 3 0 0 0 m g/ d ay in 3 d ivid ed d o ses d ep end ing
on
fo rm ulatio n available:
- ratio 8 :1 : 3 0 0 0 m g/ d ay = 2 tablets o f 5 0 0 / 6 2 .5 m g, 3 tim es/ d ay
- ratio 7 :1 : 2 6 2 5 m g/ d ay = 1 tablet o f 8 7 5 / 1 2 5 m g, 3 tim es/ d ay
• A d ap t analgesics to the p ain level (see Pain, p age 2 9 ).
• A p p ly co m p resses so ak ed in 7 0 % alco ho l, 2 tim es/ d ay (m axim um 3 tim es/ d ay
to
p revent burns to the sk in).
I f th ere is im p ro vem ent after 4 8 h o urs: co ntinue antibio tic treatm ent fo r 5 d ay s to
co m p lete 7 d ay s o f treatm ent.
I f there is no im p ro vem ent after 4 8 ho urs o f co rrect treatm ent: treat surgically .
Surgical drainage (sup p urative stage)
Material
– S terile scalp el hand le and blad e
– S terile curved , no n-to o thed artery fo rcep s (Kelly ty p e)
– S terile glo ves
– A ntisep tic
– 5 o r 1 0 m l sy ringe
– N o n-abso rbable sutures
– S terile co rrugated d rain
274
