What are the red flags for skin abscess & boils in urgent care?

Perianal, pilonidal, breast or hand abscess → Surgical / specialist referral, not clinic I&D; Facial abscess in the “danger triangle” → Specialist advice; Systemically unwell, spreading cellulitis → Antibiotics ± admission; Recurrent boils, family members affected → Consider PVL-Staph aureus — swab, decolonisation per microbiology; IV drug user, abscess near vessels → Ultrasound first — pseudoaneurysm risk

What should I prescribe for skin abscess & boils?

Paracetamol: 1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk) (As needed); Ibuprofen: 400 mg three times a day with food (3–5 days. Avoid: NSAID-sensitive asthma, GI bleed/ulcer, renal impairment, anticoagulants, heart failure, pregnancy); Antibiotics (only if surrounding cellulitis, systemically unwell, or high-risk): Flucloxacillin 500 mg–1 g four times a day (penicillin allergy: clarithromycin 500 mg twice a day) (5–7 days)

What safety-netting advice should I give for skin abscess & boils?

Advise the patient to return or seek help if: Redness spreading, fever, feeling unwell; Abscess fills up again; Severe pain.

Skin Abscess: Incision & Drainage | Urgent Care Clinic

1Rule out first — red flags

If you find…	…then
Perianal, pilonidal, breast or hand abscess	Surgical / specialist referral, not clinic I&D
Facial abscess in the “danger triangle”	Specialist advice
Systemically unwell, spreading cellulitis	Antibiotics ± admission
Recurrent boils, family members affected	Consider PVL-Staph aureus — swab, decolonisation per microbiology
IV drug user, abscess near vessels	Ultrasound first — pseudoaneurysm risk

4Decide — investigate only if it changes the plan

Investigation	Only if…
Swab of pus	Recurrent, failed treatment or suspected PVL
Capillary glucose	Recurrent abscesses

5Treat & send home

Management & advice

Incision and drainage under local anaesthetic (if trained and site appropriate)
Break up loculations; irrigate; packing usually not needed for small abscesses
Warm compresses for small, non-fluctuant boils
Wound check / dressing at GP practice in 48 h

Refer / follow-up

Perianal / pilonidal / breast / hand / large or deep → surgical team

℞

Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.

Drug	Dose	Duration / notes
Paracetamol	1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk)	As needed
Ibuprofen	400 mg three times a day with food	3–5 days. Avoid: NSAID-sensitive asthma, GI bleed/ulcer, renal impairment, anticoagulants, heart failure, pregnancy
Antibiotics (only if surrounding cellulitis, systemically unwell, or high-risk)	Flucloxacillin 500 mg–1 g four times a day (penicillin allergy: clarithromycin 500 mg twice a day)	5–7 days

6Safety-net

Say it like this

The best treatment for an abscess is letting the pus out, which we’ve done. You don’t need antibiotics because the infection hasn’t spread into the skin around it. Keep it covered, and the practice nurse will check it in 2 days. Come back if the redness spreads, it fills up again, or you feel feverish.

Come back / call 111 — or 999 if severe — if:

Redness spreading, fever, feeling unwell
Abscess fills up again
Severe pain

7Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Skin abscessnhs.uk/conditions/abscess

8Document

Skin abscess & boils — clinic note

A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.

URGENT CARE — SKIN ABSCESS & BOILS PRESENTING COMPLAINT: HISTORY Duration, size, discharge: Fever, feeling unwell: Recurrent? Contacts affected?: Diabetes, immunosuppression, IVDU: Allergies: RED FLAGS (record present / absent) [ ] Perianal, pilonidal, breast or hand abscess [ ] Facial abscess in the “danger triangle” [ ] Systemically unwell, spreading cellulitis [ ] Recurrent boils, family members affected [ ] IV drug user, abscess near vessels PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Size, fluctuance, overlying cellulitis: Obs: Site (refer special sites): INVESTIGATIONS: none required / Swab of pus, Capillary glucose — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Skin abscess Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Redness spreading, fever, feeling unwell - Abscess fills up again - Severe pain Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:

✓Guidelines

Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.

More wounds, burns & skin

Lacerations & wound careClose it right, check tetanus, and know which wounds aren’t yours.Minor burns & scaldsCool, cover, size it — and know when it goes to the burns unit.Human & animal bitesWho gets prophylaxis, rabies risk and the fight bite.Insect bites, stings & tick bitesBig local reactions vs infection vs anaphylaxis — and Lyme.