Cutaneous abscess — Clinical guidelines — Diagnosis and treatment manual — MSF Clinical guidelines — Médecins Sans Frontières 2026

Q: How long should a drain remain in place after abscess drainage?

Drains are only necessary for deep abscesses. When used, the drain should be withdrawn progressively and then removed completely after 3–5 days.

MSFClinical guideline (chapter)Current edition

From Clinical guidelines — Diagnosis and treatment manual › Chapter 10: Medical and minor surgical procedures · Médecins Sans Frontières, Current online edition, 2026

MSF clinical guidance on diagnosis, surgical management and antibiotic stewardship for cutaneous abscesses in resource-limited settings.

In one sentenceCutaneous abscesses require surgical incision and drainage under aseptic conditions; antibiotics only for systemic infection, extensive cellulitis, or immunocompromised/diabetic patients; refer anatomically complex locations to surgeon.

Issuer: Médecins Sans Frontières
Edition: Current online edition, 2026
Audience: General practitioners, emergency physicians, clinical officers, nurses in primary care and emergency settings
Evidence: Expert consensus based on MSF field experience
Reviewed: 22 Oct 2026 · GMJ

Read the original on MSF Whole guideline (PDF)

Summary by GMJ Guidelines Desk•Reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD•Record updated 22 Oct 2026•Next check Apr 2027

What this guideline says

GMJ summary

This MSF clinical guideline provides comprehensive management guidance for cutaneous abscesses, defined as collections of pus within the dermis or subcutaneous tissue most commonly caused by Staphylococcus aureus. The guideline emphasises that surgical incision and drainage under aseptic conditions is the primary treatment, with antibiotic therapy reserved only for specific indications: signs of systemic infection, extensive surrounding cellulitis, or immunocompromised/diabetic patients.

The document provides detailed procedural guidance including equipment requirements, anaesthesia protocols based on abscess size and patient age, and a four-step surgical technique (incision, digital exploration with breakdown of loculi, washing with 0.9% sodium chloride, and drainage for deep abscesses). Specific anatomical locations requiring surgical referral are identified: anterior and lateral neck, central triangle of the face, hand, perirectal region, breast, areas adjacent to major blood vessels, and those involving joint and bone.

The guideline promotes judicious antibiotic use by clearly limiting indications, supporting antimicrobial stewardship in settings where overuse is common. For anaesthesia, it recommends 1% lidocaine without epinephrine (15–20 ml) for small well-delineated abscesses in adults, and ketamine IM (10 mg/kg) for larger, deep, or poorly delineated abscesses in adults or any abscess in children.

Key points

For clinicians — doses and thresholds as stated in the guideline

Primary treatment is surgical incision and drainage under aseptic conditions; antibiotics are not routinely required
Antibiotic therapy indicated only for: signs of systemic infection, extensive surrounding cellulitis, or immunosuppression/diabetes
Refer to surgeon if abscess is located in anterior/lateral neck, central facial triangle, hand, perirectal region, breast, adjacent to major vessels, or involving joint/bone
For small (<5 cm) well-delineated abscesses in adults: use 1% lidocaine without epinephrine 15–20 ml
For larger (>5 cm), deep or poorly delineated abscesses in adults or any abscess in children: consider ketamine IM 10 mg/kg
Surgical technique: incision along long axis, digital exploration breaking down all loculi, abundant washing with 0.9% sodium chloride, drainage only for deep abscesses
Drains should be withdrawn progressively and removed completely after 3–5 days
Complications include osteomyelitis, septic arthritis and septic shock; obtain radiography if bone/joint involvement suspected

Anaesthesia approach by abscess characteristics

Table extracted from the guideline

Patient/abscess characteristics	Anaesthesia recommendation	Agent and dose
Small (<5 cm), well delineated abscess in adults	Local anaesthesia	1% lidocaine without epinephrine (10 mg/ml): 15–20 ml
Larger (>5 cm), deep or poorly delineated abscess in adults	Procedural sedation or general anaesthesia	Ketamine IM: 10 mg/kg
Any abscess in children	Procedural sedation or general anaesthesia	Ketamine IM: 10 mg/kg

Source: Médecins Sans Frontières, Cutaneous abscess — Clinical guidelines — Diagnosis and treatment manual — MSF Clinical guidelines. Reproduced in summary form.

From the guideline

Verbatim

“Treatment is surgical incision and drainage, under aseptic conditions (i.e. sterile consumables and instruments, antiseptic skin preparation).”

— Médecins Sans Frontières, Cutaneous abscess — Clinical guidelines — Diagnosis and treatment manual — MSF Clinical guidelines, Treatment section (2026)

Editor’s perspective

Why this matters for Georgia and the region

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration

As Editor-in-Chief of the Georgian Medical Journal and Chair of the Public Health Institute of Georgia, I recognize this MSF guideline addresses a common clinical scenario where antibiotic overuse remains problematic across Georgia and neighbouring countries. The clear restriction of antibiotics to specific indications—systemic infection, extensive cellulitis, or immunocompromised patients—is the recommendation I would emphasize to Georgian clinicians, as it directly supports our national antimicrobial resistance containment efforts. The detailed surgical technique with specific anatomical referral criteria is practical for our primary healthcare settings. However, implementation will require training programmes to ensure primary care physicians are confident performing incision and drainage procedures, and establishing reliable referral pathways from rural facilities where surgical backup may be hours away.

ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 22 Oct 2026

Applicability

Georgia and the South Caucasus

This guideline is highly relevant for Georgia and the South Caucasus region, where cutaneous abscesses are common presentations in primary care and emergency departments. The emphasis on surgical management as primary treatment with restricted antibiotic use aligns with national antimicrobial stewardship priorities across the region, where antibiotic overuse remains a concern. Georgian healthcare programmes would need to ensure availability of basic surgical equipment and trained personnel in primary care settings to perform incision and drainage procedures, and establish clear referral pathways to surgical services for anatomically complex cases. The anaesthesia protocols are practical for resource-constrained settings common in rural areas of Georgia, Armenia and Azerbaijan, though availability of ketamine and procedural sedation capacity would need verification at facility level.

Questions this guideline answers

Quick answers

When should antibiotics be prescribed for a cutaneous abscess?

Antibiotics are indicated only when there are signs of systemic infection, extensive surrounding cellulitis, or when the patient has risk factors such as immunosuppression or diabetes. Uncomplicated abscesses require only surgical drainage, not antibiotics.

Which cutaneous abscesses require surgical referral?

Refer to a surgeon if the abscess is located in the anterior or lateral neck, central triangle of the face, hand, perirectal region, or breast; if it is adjacent to major blood vessels (e.g. femoral artery); or if it involves joint and bone.

What anaesthesia should be used for a small superficial abscess in an adult?

For small (approximately <5 cm), well-delineated abscesses in adults, use local anaesthesia with 1% lidocaine without epinephrine (10 mg/ml): 15–20 ml.

How long should a drain remain in place after abscess drainage?

Drains are only necessary for deep abscesses. When used, the drain should be withdrawn progressively and then removed completely after 3–5 days.

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Cutaneous abscess — Clinical guidelines — Diagnosis and treatment manual — MSF Clinical guidelines

What this guideline says

Key points

Anaesthesia approach by abscess characteristics

From the guideline