Empiric Therapy Regimens

Empiric therapeutic regimens for cutaneous abscess are outlined below, including those for outpatients and inpatients. Recommendations for prevention are also provided:

Antibiotic efficacy in the abscess is limited owing to the acidic and relatively protected environment; therefore, the first-line therapy for a cutaneous abscess is surgical.^[1]Incision and drainage should be performed initially, with or without systemic antibiotics.^{[2, 3, 4]}

Bacterial culture should be obtained from the purulent fluid during the incision and drainage procedure. While empiric antibiotics may be prescribed at first, therapy may be altered or narrowed based on culture and antibiotic susceptibility results.

The use of postoperative antibiotic therapy should be reserved for high-risk cases. Included in this group are immunocompromised states from diabetes, AIDS, asplenia, or blood dyscrasias; recurrent cases of abscess and cellulitis; and systemic signs and symptoms of infection such as fever or leukocytosis.^[5]

Empiric antimicrobial therapy for more serious infections should cover methicillin-resistant Staphylococcus aureus (MRSA).

Treatment recommendations

Outpatient recommendations are as follows:

Clindamycin 300-450 mg PO q8h for 5-7d or
Cephalexin 250-500 mg PO q6h for 5-7d or
Dicloxacillin 250-500 mg PO q6h for 5-7d or
Doxycycline 100 mg PO q12h for 5-7d or
Trimethoprim-sulfamethoxazole (160 mg/800 mg) DS 1-2 tablets PO q12h for 5-7d

Inpatient recommendations are as follows:

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

Prevention

MRSA colonization may be eliminated via the following regimen:

Mupirocin ointment applied intranasally twice daily for 5 days is highly effective for eradicating MRSA, with a success probability of approximately 90% 1 week post treatment.^[6]There may also be a role for whole body chlorhexidine wash.^[7]