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Abscesses, Boils and Carbuncles (DRAFT)

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Overview

Please see Boils, carbuncles, and staphylococcal carriage | CKS | NICE (1) for advice on diagnosis and management of boils and abscesses in primary care and when to consider referral.

Please note that benign cysts and skin lesions that are not infected and do not need immediate/urgent care should not be referred unless criteria for Prior Approval have been met. See the Benign Skin Lesions page for details.

Management in Primary Care (summary)

Small boils will usually drain spontaneously after application of moist heat. See Acute boils or carbuncles for further details.

If infection is suspected then assess for surrounding cellulitis and systemic symptoms (check temperature, pulse and BP if clinically indicated - this information may be requested if a referral is being made).

Consider taking swabs of pus from the lesion and initiating antibiotic therapy depending on clinical judgement (2).

If incision and drainage is required then then consider performing in primary care if the lesion is small and the expertise and facilities are available. Otherwise, the person should be referred to a surgical unit (1) (see referral sections below).

Please also consider the advice on the following Remedy pages which may be appropriate:

Hidradenitis Suppurativa - consider if chronic/multiple boils
Dental Care- for dental abscesses
Acne vulgaris
Diabetes Foot Care - consider if active foot problem in a patient with diabetes
Benign-skin-lesions policy

Paediatric Referrals

For children aged under 16 years old who need urgent assessment, please contact children's ED. Please see the Urgent Care Referrals page for details.

Who to Refer

Arrange for urgent incision and drainage for patients with:

Large and/or fluctuant boils.
Carbuncles.
Abscesses not responding to management in primary care.

Consider admission for intravenous antibiotics if the person:

Is systemically unwell.
Has cellulitis.
Has an infection in an area where complications can be serious (such as the face).
Is immunocompromised as a result of an underlying disease (such as diabetes) or medication (such as corticosteroids).

NBT Referrals

See attached NBT GI Surgery Abscess pathway

This includes advice on appropriate referral route for abscesses depending on anatomical site.

Patient Information

Treatment of abscesses | North Bristol NHS Trust

UHBW Referrals

See Surgical Emergency Care page for contact details of acute ambulatory care for BRI and Weston.

Resources

(1) Boils, carbuncles, and staphylococcal carriage | Health topics A to Z | CKS | NICE

(2) BNSSG Primary Care Antimicrobial Guidelines

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.