A 10-month-old infant develops a fluctuant, non-draining abscess after antibiotic therapy for impetigo; what is the next step?

A 10-month-old infant develops a fluctuant, non-draining abscess after antibiotic therapy for impetigo; what is the next step?

• A. Consultation with a pediatric infectious disease specialist
• B. Culture of any superficial open surface wounds
• C. Empiric treatment with clindamycin
• D. Incision and drainage of the abscess with culture

Answer: (B)

When a skin abscess is present, the priority is to remove the source of infection by draining the pus. A fluctuant abscess represents a pocket of pus that antibiotics alone struggle to penetrate, so opening and evacuating the collection provides immediate relief, speeds healing, and reduces the risk of spread. After drainage, obtaining a culture from the drained material helps identify the responsible organism and guides any needed antibiotic therapy, especially if MRSA is a concern in your community. Draining the abscess addresses the central issue—the pus pocket—whereas simply culturing superficial wounds wouldn’t resolve the collection and could delay effective treatment. In this scenario, the best next step is incision and drainage of the abscess with culture to tailor further management.

When a skin abscess is present, the priority is to remove the source of infection by draining the pus. A fluctuant abscess represents a pocket of pus that antibiotics alone struggle to penetrate, so opening and evacuating the collection provides immediate relief, speeds healing, and reduces the risk of spread. After drainage, obtaining a culture from the drained material helps identify the responsible organism and guides any needed antibiotic therapy, especially if MRSA is a concern in your community.

Draining the abscess addresses the central issue—the pus pocket—whereas simply culturing superficial wounds wouldn’t resolve the collection and could delay effective treatment. In this scenario, the best next step is incision and drainage of the abscess with culture to tailor further management.