From the Guidelines
Antibiotics should only be prescribed for pilonidal cysts when there is evidence of infection, and the choice of antibiotic should be guided by culture results when possible. For infected pilonidal cysts, a 5- to 10-day course of an antibiotic active against the pathogen isolated is recommended 1. Common antibiotic regimens include oral clindamycin, trimethoprim-sulfamethoxazole, or a combination of metronidazole plus either ciprofloxacin or cephalexin. However, the primary treatment for pilonidal cysts involves addressing the underlying cause, which may include drainage of the abscess if present, and possibly surgical excision for recurrent cases.
Some key considerations in the management of pilonidal cysts include:
- Identifying and addressing local causes of recurrent abscesses, such as pilonidal cysts or foreign material 1
- Draining and culturing recurrent abscesses early in the course of infection 1
- Considering decolonization regimens for patients with recurrent S. aureus infections, although the evidence for this is weak and of low quality 1
- Evaluating patients for neutrophil disorders if recurrent abscesses began in early childhood 1
It's also important to note that antibiotics alone will not resolve the underlying cyst and are considered adjunctive therapy. Patients should complete the full antibiotic course even if symptoms improve, maintain good hygiene of the area, avoid sitting for prolonged periods, and seek medical attention if symptoms worsen or don't improve within 48-72 hours of starting antibiotics.
From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci Anaerobes: Serious skin and soft tissue infections;
The antibiotic treatment for pilonidal cyst is clindamycin as it is indicated for the treatment of serious skin and soft tissue infections caused by susceptible anaerobic bacteria, which may be present in pilonidal cysts 2.
From the Research
Antibiotic Treatment for Pilonidal Cyst
- The provided studies do not directly address the use of antibiotics for pilonidal cyst treatment [ 3, 4 ].
- However, studies on cellulitis treatment suggest that antibiotics are usually not beneficial for skin abscess and national guidelines do not recommend coverage for non-purulent cellulitis [ 3, 4 ].
- For pilonidal disease, the focus is on surgical and non-surgical management, with an emphasis on minimally invasive procedures and prevention of disease recurrence [ 5, 6, 7 ].
- There is no clear evidence to support the use of antibiotics as a primary treatment for pilonidal cysts, and the management of pilonidal disease is focused on other treatment modalities [ 5, 6, 7 ].
Treatment Options for Pilonidal Disease
- Conservative nonoperative management strategies, including improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity [ 7 ].
- Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities [ 7 ].
- Minimally invasive operative approaches, including sinusectomy and endoscopic approaches, have been shown to be effective in managing pilonidal disease [ 5, 7 ].
Limitations of Current Evidence
- The current evidence supporting different treatment options for pilonidal disease is limited by study quality, with inconsistent characterization of disease severity and variable definitions and reporting of treatment-associated outcomes [ 7 ].
- There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms [ 7 ].