Perirectal Abscess Medication

Antibiotics are unnecessary in otherwise healthy individuals. The practitioner should provide appropriate empiric intravenous antibiotic coverage for patients who are elderly or immunosuppressed, patients who have comorbidities, patients with a heart valve abnormality or prosthetic valve likely to benefit from antibiotic prophylaxis, or those in whom infection has become systemic. Predisposing or comorbid factors may guide empiric antibiotic selection. If antibiotics are considered, increasing MRSA prevalence should be taken into account, with vancomycin and trimethoprim-sulfamethoxazole showing excellent coverage according to a 2009 study.^[7]

Analgesia is necessary for pain control and may be given orally or via an intravenous route, in conjunction with anesthetics if needle aspiration or incision and drainage of an abscess is performed.

Anxiolytics may help certain patients who are apprehensive about needle aspiration, I& incision and drainage, imaging studies, or surgery.

Class Summary

Appropriate antibiotic coverage should be given intravenously preoperatively and postoperatively, either based on Gram stain or an empiric basis, as a preventive measure, for elderly patients, patients with immunosuppression, patients with heart valve abnormality or prosthesis, and those with comorbid states.

Ampicillin and sulbactam (Unasyn)

Drug combination of beta-lactamase inhibitor with ampicillin. Interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. Alternative to amoxicillin when unable to take medication PO.

Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.

Imipenem cilastatin (Primaxin)

Should be used for more severely ill ICU patients empirically. Pus and/or blood culture and sensitivity results, once available, should guide antibiotic selection. Predisposing and comorbid diseases may also guide empiric antibiotic selection.

Ampicillin (Marcillin, Omnipen, Polycillin)

Broad-spectrum penicillin. Interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. Alternative to amoxicillin when unable to take medication PO.

Those with prosthetic heart valves at risk for endocarditis should receive IV prophylactic antibiotics prior to any procedure. Ampicillin IV should be used, unless the patient is penicillin allergic, in which case cefazolin or clindamycin are appropriate choices.

Cefazolin (Ancef, Kefzol, Zolicef)

First-generation semisynthetic cephalosporin that by binding to 1 or more penicillin-binding proteins arrests bacterial cell wall synthesis and inhibits bacterial replication. Poor capacity to cross blood-brain barrier. Primarily active against skin flora, including S aureus. Typically used alone for skin and skin-structure coverage. Regimens for IV and IM dosing are similar. Primarily active against skin flora, including S aureus. Use in penicillin-allergic patients with prosthetic heart valves at risk for endocarditis.

Clindamycin (Cleocin)

Semisynthetic antibiotic produced by 7(S)-chloro-substitution of 7(R)-hydroxyl group of parent compound lincomycin. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Widely distributes in the body without penetration of CNS. Protein bound and excreted by the liver and kidneys.

Use in penicillin-allergic patients with prosthetic heart valves at risk for endocarditis.

Class Summary

These agents may help to blunt the pain of a diagnostic needle aspiration but is only partially effective.

Lidocaine 1% (Xylocaine)

Decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. Ethylene chloride may be used in conjunction with lidocaine to blunt the pain of a diagnostic needle aspiration but is only partially effective. It should be sprayed over the area to be aspirated immediately prior to aspiration.

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who experience pain. These agents are used for comfort and sedation and to blunt discomfort of diagnostic needle aspiration.

Meperidine (Demerol)

Analgesic with multiple actions similar to those of morphine; may produce less constipation, smooth muscle spasm, and depression of cough reflex than similar analgesic doses of morphine. May use in combination with promethazine to provide synergistic effect.

Class Summary

These agents are used to treat emesis.

Promethazine (Phenergan)

Antidopaminergic agent effective in treating emesis. Blocks postsynaptic mesolimbic dopaminergic receptors in brain and reduces stimuli to brainstem reticular system. May use in combination with meperidine to provide synergistic effect.

Class Summary

By binding to specific receptor sites these agents appear to potentiate the effects of γ -aminobutyric acid (GABA) and to facilitate inhibitory GABA neurotransmission and other inhibitory transmitters. Benzodiazepines are anxiolytics that may help patients apprehensive about needle aspiration, imaging studies, or surgery. Conscious sedatives may be considered by the emergency physician with equipment and experience necessary to manage the patient's airway if spontaneous ventilation become compromised.

Midazolam (Versed)

Shorter-acting benzodiazepine sedative-hypnotic useful in patients who require acute and/or short-term sedation. Midazolam is also useful for its amnestic effects.

Lorazepam (Ativan)

Sedative hypnotic with short onset of effects and relatively long half-life.

By increasing the action of GABA, which is a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation.

When patient needs to be sedated for longer than 24-h period, this medication is excellent.