Reviewed and updated August 2026. Originally published March 2012.

I am Scott Rennie, DO, board certified in Family Medicine and Obesity Medicine. I practice entirely by telemedicine, licensed in all 50 states. Most of my work now is weight loss, metabolic health and menopause care. If this was useful, Start here lists what I write about now.

“Staph” infections are most often caused by the organism Staphylococcus aureus, a bacterium that is carried on the skin of about 30% of healthy individuals.  Most of the time, these bacteria do not cause any symptoms. They just hang out on the skin because the skin is a natural layer of defense against infections.  If the skin is damaged, even from a small scratch however, Staph can cause anything from a mild skin infection to a severe, life-threatening illness, especially in young children or older adults. The difference between normal Staph infections and MRSA Infections:  Staph infections in the past were treated with antibiotics such as penicillin.  Some strains of Staph have unfortunately become resistant to penicillin and related antibiotics.  These strains of MRSA cannot be cured with traditional penicillin-related medications.  MRSA is now found in up to 70% of people in the community with a diagnosed staph infection. The spread of MRSA:  Many people become “colonized” with MRSA and that means that they carry the bacteria on their skin or in their nose.  It doesn’t cause any problems unless there is an opening in the skin from a scratch or cut.  You can become colonized with MRSA bacteria in several ways: 1)   Touching the skin of someone else who has been colonized with MRSA 2)   By touching or inhaling small droplets from breathing, coughing or sneezing 3)   By touching a contaminated surface such as a phone headset, countertop or door handle Community MRSA:  You can more easily pick up MRSA by: 1)   Being overweight or obese 2)   Shaving body hair 3)   Sharing personal items or equipment that is not cleaned 4)   Skin trauma such as turf burns, cuts or sores 5)   Physical contact with someone with a draining cut or sore that has MRSA Symptoms:  A skin infection is the most common symptom and it may be mistaken for a spider bite.  A raised, red lump that is tender or cluster of  “pimples,” or large tender lump that drains pus may also be present.  If the bacteria enter the bloodstream, it is possible to develop an infection in areas other than the skin.  A staph infection can occur in a heart valve, inside a bone, a joint or in an implanted device such as an IV line, pacemaker or replacement joint.  Symptoms of these types may include fever, fatigue as well as swelling in the infected area. Diagnosis:  To actually diagnose a true MRSA infection, a culture of the infected area must be performed.  A small sample of bacteria or pus collected from the skin or bloodstream is collected and allowed to grow in an environment that the bacteria thrive in, and then we test these bacteria for resistance to certain antibiotics, including penicillin. Treatment:  in patients with community acquired MRSA we use antibiotics that may be different than patients who develop MRSA in the hospital.  This is because community acquired MRSA is usually sensitive to antibiotics such as Bactrim, clindamycin, or doxycycline.  MRSA that is acquired in the hospital often has to be treated with antibiotics given through an IV such as Vancomycin. A surgical procedure called an I&D (incision and drainage) can be done to drain the pus and heal the infection. If you’ve had an incision and drainage done at your doctor’s office:  After having a surgical procedure done at your doctors office, the wound is often packed with sterile gauze to allow the wound to heal from the bottom upwards.  This way, the wound doesn’t close up at the top and leave a space underneath the top of the skin where bacteria can start growing and cause an infection.  This type of wound needs special attention and observation each day. Basics of wound care after an I&D (incision and drainage): 1)   Keep the bandage/wound clean and dry. 2)   Only remove the bandage to clean around the wound and follow the advice of your medical provider on how to do this. 3)   The packing gauze should be removed little by little until the wound heals completely.  The decision on how much to remove (if any) should be made by a medical provider but this can be explained to the patient on an individual basis (ie. Wounds heal differently depending on the situation). 4)   You may need to wear a splint to decrease movement to the area and allow wound healing. 5)   Antibiotics and pain medication may be prescribed. Prevention:  The CDC has made several recommendations about how to prevent and control MRSA in our communities: 1)   Wash hands with soap and water paying special attention to the fingernails, wrists and between the fingers. 2)   If a sink is not available, alcohol-based hand sanitizers are a good alternative. 3)   Cover all cuts and scrapes and keep them clean until healed. 4)   Don’t touch wounds or bandages from other people 5)   Avoid sharing towels, razors, clothing, uniforms, towels, brushes, combs, make-up and towels. 6)   Athletes should shower after every sports activity and use soap and clean towels. 7)   Exercise equipment at sports clubs and schools should be wiped down with an alcohol-based solution after using it. Care for family members:  Our guidelines do not recommend that family members with MRSA be treated with antibiotics.  Proper preventative measures as described above, should be used. Should I be tested?:  Experts do not recommend widespread testing for MRSA because of the small risk of infection.  Currently only 4 out of 10,000 people in our communities develop a MRSA infection per year.   I hope that you have found this information useful.  Wishing you the best of health,

Recurrent boils and abscesses are one of the reasons I end up asking about someone’s blood sugar, since diabetes both invites skin infections and slows the healing after they are drained. If that is where you are, start with what a new diagnosis of type 2 diabetes actually means. Most of my writing now is obesity and metabolic medicine, including what Wegovy and Zepbound cost without insurance.

Updated for 2026: What Has Changed Since I Wrote This

I first published this in 2012. Most of it held up. One part did not, and the change matters enough that I would rather correct it here than leave it sitting. Back then the teaching was that a small abscess, once drained, did not need antibiotics. Drainage was the treatment. Antibiotics were for people who looked sick, ran a fever, or had redness spreading past the lump. That is what I wrote. It is what most of us were taught. Two randomized trials changed it. In 2016, Talan and colleagues published a placebo-controlled trial in the New England Journal of Medicine. Everyone got drainage. Half then got trimethoprim-sulfamethoxazole and half got placebo. Cure was 92.9 percent with the antibiotic against 85.7 percent with placebo (1). The following year Daum and colleagues ran a similar trial in smaller abscesses, adults and children together, comparing clindamycin, TMP-SMX, and placebo after drainage. Cure came in at 83.1 percent, 81.7 percent, and 68.9 percent. Clindamycin had fewer recurrences, 6.8 percent against 13.5 percent, and more diarrhea (2). Drainage still does the heavy lifting. But adding an antibiotic afterward buys a real, measurable improvement, and I now recommend it for most drained abscesses instead of holding it back for the ones who look ill. One limit worth knowing, because it cuts the other way. The benefit is specific to pus. In 2017 Moran and colleagues tested cephalexin plus TMP-SMX against cephalexin alone in uncomplicated cellulitis with no abscess. No difference, 83.5 percent against 85.5 percent (3). No pocket of pus, no reason to add MRSA coverage.

What This Actually Means on a Video Visit

I practice entirely by video, so let me be straight about what I can and cannot do with an abscess on a screen. I can look at it. I can ask you to press on it and tell me whether it feels like a firm knot or a soft pocket that gives under your finger. I can ask how fast it came up, whether you have had fever, how your blood sugars have been running. What I cannot do is drain it. If there is pus under there, somebody has to open it, and that somebody has to be in the room with you. So here is the honest version. Send me a photo of a red, painful, fluctuant lump and I am going to tell you it needs to be drained, and help you work out where to go. Once it has been drained, the antibiotic afterward is something I can handle from here without any trouble.

When You Need To Be Seen Today

Fever or chills. Redness spreading well past the edge of the lump. An abscess on your face, particularly near your eyes or nose. Poorly controlled diabetes, or a suppressed immune system. No improvement forty eight hours after drainage and antibiotics. Any of those and you belong in front of someone in person, not on a screen (4).

The Bottom Line

Cutting it open is still what fixes an abscess. The 2012 version of this post told you that was usually enough by itself. The evidence since then says an antibiotic afterward makes a real difference, and that is how I practice now.

Related Reading

Why Do I Keep Getting Boils? When to Use Telemedicine vs. Urgent Care: How I Spot the Sick One Allergic Antibiotic Drug Reactions: Am I Truly Allergic to Penicillin? Cellulitis – a soft tissue/skin infection – is it MRSA? What is Hidradenitis suppurativa? Pilonidal Cysts – A pain in the rear Epidermal Inclusion Cysts Explained: What Are They?

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Sources

1. Talan DA, et al. Trimethoprim-Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess. N Engl J Med. 2016;374(9):823-832. https://pmc.ncbi.nlm.nih.gov/articles/PMC4851110/ 2. Daum RS, et al. A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses. N Engl J Med. 2017. https://pmc.ncbi.nlm.nih.gov/articles/PMC6886470/ 3. Moran GJ, et al. Effect of Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis. JAMA. 2017;317(20):2088-2096. https://jamanetwork.com/journals/jama/fullarticle/2627970 4. Stevens DL, et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update. Clin Infect Dis. 2014;59(2):e10-e52. https://www.idsociety.org/practice-guideline/skin-and-soft-tissue-infections/

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