Cutaneous Abscess Organism-Specific Therapy

Organism-specific therapeutic regimens for cutaneous abscess are provided below, including those for Staphylococcus aureus, streptococci, Enterobacteriaceae, Bacteroides spp, and Pasteurella multocida.[1, 2, 3, 4, 5, 6]

An assessment of the likely organisms involved is necessary; this involves determining the location of the abscess, the immunocompetence of the patient, and the route of entry (eg, as a foreign body).

In 2014, the FDA approved 3 new antibiotics, oritavancin (Orbactiv), dalbavancin (Dalvance), and tedizolid (Sivextro), for the treatment of acute bacterial skin and skin structure infections. These agents are active against Staphylococcus aureus (including methicillin-susceptible and methicillin-resistant S aureus [MSSA, MRSA] isolates), Streptococcus pyogenes, Streptococcus agalactiae, and Streptococcus anginosus group (includes Streptococcus anginosus, Streptococcus intermedius, and Streptococcus constellatus), among others. For complete drug information, including dosing, see the following monographs:

• Oritavancin

• Dalbavancin

• Tedizolid

Methicillin-sensitive S aureus (MSSA)

See the list below:

• Cefazolin 500-1000 mg IV q6-8h or

• Clindamycin 300-600 mg PO q8h or

• Nafcillin 500-2000 mg IV or IM q4-6h or

• Ampicillin-sulbactam 1.5 g IV q6h or

• Dicloxacillin 250-500 mg PO q6h or

• Doxycycline 100 mg PO q12h or

• Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1-2 DS tablets PO q12h for 5-7d

Methicillin-resistant S aureus (MRSA)

See the list below:

• Vancomycin 15 mg/kg IV q12h or

• Daptomycin 4 mg/kg IV daily or

• Linezolid 600 mg PO or IV q12h or

• Clindamycin 600 mg PO or IV q8h or

• Doxycycline 100 mg PO q12h or

• Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1-2 DS tablets PO q12h for 5-7d

Streptococci

See the list below:

• Ampicillin 1000-2000 mg IV q6h or

• Cefazolin 500-1000 mg IV q6-8h or

• Clindamycin 150-450 mg PO q6h or

• Azithromycin 500 mg/day PO

Enterobacteriaceae (abscesses of axilla, perineum, and groin)

See the list below:

• Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1-2 DS tablets PO q12h for 5-7d or

• Amoxicillin-clavulanate 875 mg/125 mg PO q12h for 5-7d or

• Ciprofloxacin 500-750 mg PO q12h for 5-7d or

• Levofloxacin 250-500 mg/day PO for 5-7d

Bacteroides spp (abscesses caused by IV drug use or human bites; axilla, perineum, and groin)

See the list below:

• Clindamycin 150-450 mg PO q6h for 5-7d or

• Metronidazole 500 mg PO q6h for 5-7d or

• Amoxicillin-clavulanate 875 mg/125 mg PO q12h for 5-7d

Pasteurella multocida (abscesses caused by animal bites, especially cat bites)

See the list below:

• Penicillin VK 250-500 mg PO q6h for 5-7d or

• Doxycycline 100 mg PO q12h for 5-7d

Prevention

See the list below:

• Sanitation includes hand washing and good hygiene

• Control of outbreaks may involve washing with chlorhexidine soaps and washing of all clothes and towels

• MRSA carriage can be eradicated with nasal mupirocin and chlorhexidine soaps

Special considerations

See the list below:

• Ultrasonography may prove helpful in identifying the size and extent of an abscess

• Radiography may assist in the detection of foreign bodies

• Carbuncles are deeper infections involving the deep cutaneous layer and usually the subcutaneous fat

• Common cutaneous abscesses include infected sebaceous cyst, infected Bartholin gland, and pilonidal abscess

• Felon and paronychia are abscesses of the fingers or thumbs

• Hidradenitis suppurativa is a recurrent infection of the epithelium within apocrine gland–containing skin that leads to chronic abscesses, usually in the groin or axillae

Guidelines

The Infectious Diseases Society of America recently updated their guidelines for the diagnosis and management of skin and soft tissue infections. For the full guidelines, see Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America.[7, 8]