I have an abscess on my leg - antibiotics not working - what to do?

[skinissue]

I am at my wits end and would be very grateful for any help or advice.

I have a skin abscess at the top of my inner thigh measuring about 2.5 inches and it is very red, hot, angry, and most of all - painful.

Had this about 8 days and I am on a 7 day course of Flucloxaxillin - 1,000mg (4 tablets per day) so strong dose.

In short, it has not cleared up at all and is still pretty much the same size, redness, and swelling. It is perhaps around 10% less painful, but there is no 'head' or any part of it that looks as though pus will emerge, but a small part of the top of it looks as though it might be starting to yellow slightly and perhaps scab over.

It is so so painful as every time I walk it rubs against my other leg and sitting / standing / turning over in bed / bending / using the loo are all agony.

Questions:

• Do I need an incision and drainage?
• Are these procedures typically successful and what is the approximate recovery period?
• Should I go to my local A&E to get this done? Want to avoid my GP for personal reasons that I don't have the post length to get into right now.

Thank you in advance!

I have been told by a couple of doctors already that it can be difficult and sometimes not possible to sufficiently numb the area with local anaesthetic and so general anaesthetic can be needed. That part of the post I can therefore corroborate.

@skinissueIt is my first one, is it yours? I have a lot of issues with my immune system and so I’m quite surprised this hasn’t happened before. I would prefer to avoid I&D if I can help it but my doctor is quite risk averse given my immune system and the fact that I’ve been ill a lot this year so I’ll see what they say. I painkillers to take the edge off as well so it’s manageable. Hopefully we’ll both start feeling better soon though!

Yes this is a low dose - standard dose would be 500mg 4 times a day but for more serious infection or if you weigh more then a dose of 1g 4x a day may be required. You also need to be taking it on an empty stomach - 30 mins before eating and 2 hours after food

Ouch sounds so painful!!

Just chiming in as I had an I&D done under GA on a large lactational abscess - antibiotics didn’t help, and aspiration under local didn’t sort it, the bugger. It started leaking pus and it was gonna be messy and horrible if left to its own devices, plus risk of infection spreading.

It wasn’t a nice recovery tbh - wound was left open and needed packing changed every other day for a while, so it healed from the bottom up before the incision closed. However I don’t know how it would have healed so well without the procedure and the wound care - the area is completely flat, no dent, though there is a small scar of course.

Hope you can get it sorted soon!

As someone who has had similar recently I suggest going to A&E. normally a GP will ask you to tell them if there is no improvement in taking the antibiotics after a few days and they definitely like to know if it is getting worse. You could well have an underlying infection. I’d go to A&E based on my experience where the consultant diagnosed me very quickly when no one else could figure out what it was. If I hadn’t gone, the infection would have rapidly spread and was at risk of sepsis. Sounds like you need it lanced and then an IV antibiotic

If standard dose is 500mg and I am on DOUBLE that at 1,000mg 4 x per day then how am I on a low dose?

Yeah, you might need a longer course of antibiotics, or a totally different type. I would call NHS111 or go to your nearest minor injuries unit if I were you.

As someone who does this, i can tell you he’s likely an a&e job. Some GPs don’t do this now as the funding for minor surgery has been greatly reduced so they’d sent to a&e for draining and potential packing.
There’s many indications of fluclox but essentially 1g a day is not the max dose so there are options, including alternatives like doxy

Thank you for this - it is helpful. I think I will take myself off to A&E tomorrow

Your initial post said 4 tablets a day... flucloxacillin is usually 250mg or 500mg per capsule.

It's not clear if you mean you are taking 1000mg four times a day (a total dose of 4000mg in 24 hours which is high dose) or 4 x 250mg a day (a total dose of just 1000mg a day) which is a very low dose.

It might just be you need another course of antibiotics. I was in a similar situation. Can't recall what I was prescribed but the first course did very little. GP prescribed a second course and said that if this had no effect, I would need it drained. I think it was on the second day of the second course - day 9 in total - that the swelling started to abate, as did the pain.

Don't despair just OP. Go back to the GP tomorrow.

Yes, sorry, I realise that I have not written that quite as clearly as I could have done.

I am on a total dose of 4,000mg per day but in the form of 8 tablets as the pharmacy did not have 1,000mg tablets so I take 2 x 500mg tablets four times per day.

Okay, that is worth noting, thank you. If possible I would like to avoid an endless stream of different antibiotics because of the potential health implications, and because I may then just need to have I&D in any event, but I release that I may have little choice in the matter.

I had a course of flucloxaxillin this year, first antibiotics for at least a decade. It didn’t seem to be doing much for ages, by day five I thought I’d have to get another course, and then suddenly it really was really working, and seemed to keep improving after the seven days was up. Wasn’t an abscess though.

I would contact the GP and tell them it’s not calming.

Okay so there's still hope then! I'll hold onto this for now

I had an abscess under my arm a few years ago (overseas at the time) where a cyst that I'd had for years got infected.

I was given antibiotics which did nothing. Went back after 4 days because it was just getting bigger. They gave me LA, drained it and were shocked at how big it was (I'd told them this, but I guess they didn't listen). It was silver packed. Can't remember if they stitched it closed or not.

Cyst is still there. Hasn't ever happened again.

How long did it take to heal? I'm glad it hasn't returned

Keep taking the meds
Make an appointment urgently tomorrow with GP
Have they done a swab to see if it's resistant to any antibiotics?
Do t mess around d, after 2 days you should be seeing some improvement so it needs professional guidance, even if that's that it's ok ... but doesn't sound it to me

I’ve not read the whole thread as it’s late.
However, looks up castor oil for your leg ulcer(s), there seems to be a lot of positivity for dealing with what you’re suffering with.
Good luck 🤞

Does it have to have liquid on the surface (pus) or similar to be able to swab? because it is dry and not yet an open wound

Thank you!! I will do this now

Back to GP ,Flucoxacillin 500mgs four times a day should have sorted out the abscess by now!! You probably need a E&D .

You should try seeing if you can get it to naturally drain yourself first? I had an abscess which was red, angry and painful, the GP wanted to give me antibiotics, but I declined them. Once I knew what it was from her diagnosis, I went home, boiled the kettle, poured some water into a bowl, added a few drops of tea tree oil, stuck a facecloth/flannel in, then when still hot but not too hot to handle, wrung it out and placed it on top of it and held it in place until it went cold.

When I removed the cloth, it had opened and drained itself. Instant pain relief. I did this a couple more times the next day and it was gone before I knew it.

Now, I'm just suggesting you try it now for some relief. Obviously, if it doesn't work, go to a walk-in centre or your GP to get it drained tomorrow.

ETA: If you don't have tea-tree oil, put some salt in the water, or even just plain hot boiled water.

Once it was drained it started healing pretty much straight away. I guess it was about 2 weeks until it was totally closed, but it felt better instantly.