From the Guidelines
For a tattoo that remains infected despite a 14-day course of Augmentin, the most appropriate next step is to seek immediate medical attention and consider changing the antibiotic to one that covers a broader spectrum of pathogens, such as doxycycline or a fluoroquinolone, as recommended by the Infectious Diseases Society of America guidelines 1. The persistent infection likely indicates either antibiotic resistance, a deeper infection, or possibly a non-bacterial cause.
- Key considerations include:
- The bacteriology of the wound, which can differentiate the number of isolates per wound and whether additional coverage for anaerobes is required 1
- The possibility of methicillin-resistant Staphylococcus aureus (MRSA) infection, which may require treatment with a specific antibiotic such as clindamycin or a fluoroquinolone 1
- The need for cultures to identify the specific pathogen and its antibiotic sensitivities, as empirical therapy might miss pathogens 1 Treatment may include a different antibiotic such as:
- Doxycycline 100mg twice daily, which has excellent activity against Pasteurella multocida and some streptococci, but some streptococci are resistant 1
- Trimethoprim-sulfamethoxazole DS twice daily, which has good activity against aerobes but poor activity against anaerobes 1
- A fluoroquinolone, such as ciprofloxacin or levofloxacin, plus metronidazole, or moxifloxacin as a single agent, which can provide broader empirical coverage for abscesses and anaerobes 1 In severe cases, intravenous antibiotics might be necessary.
- Wound care is also crucial, including keeping the infection site clean with gentle soap and water, avoiding harsh antiseptics, applying a thin layer of petroleum jelly, and covering with a sterile bandage, changing it daily. The infection site should be monitored closely for signs of improvement or worsening, and the patient should be advised to seek immediate medical attention if they experience any severe symptoms, such as increased redness, swelling, or purulent discharge. Persistent tattoo infections can lead to serious complications, including scarring, distortion of the tattoo, or systemic infection if left untreated 1.
From the Research
Tattoo Infection Treatment
- A 14-day course of Augmentin may not be sufficient to treat a persistently infected tattoo, as the infection may require more aggressive treatment 2, 3.
- Bacterial infections during the healing phase of a tattoo can be treated with oral antibiotics, and a list of first-line antibiotics is proposed 2.
- Severe infections with affected general condition require intravenous antibiotic treatment as early as possible to prevent septic shock and death 2, 3.
Causes of Persistent Infection
- The risk of infection depends on the triad of microbial pathogen and its aggressiveness, individual resistance of the tattooed, and inoculation and exposures by the tattoo needle and in the tattoo parlor 4.
- Tattoo inks can be a potential source of infection, with 10% of new inks contaminated with bacteria pathogenic to humans 4.
- Known brands and established manufacturers are considered safer, but work is in progress to establish common European standards for tattoo hygiene 4.
Alternative Treatment Options
- Chronic allergic reactions in red tattoos are mostly nonresponsive to topical corticoid and best treated with dermatome shaving with complete removal of the hapten concentrated in the outer dermis 3.
- Laser treatment of allergic reactions can boost the allergy with worsening and a potential risk of anaphylaxis and is thus not recommended in tattoo allergy 3.
- Chronic papulonodular reactions in black tattoos with pigment agglomeration can respond to local corticoid or be treated with dermatome shaving or lasers depending on availability 3.