From the Research
Nasal vestibulitis and abscesses should be treated with a combination of topical and oral antibiotics, along with warm compresses and proper hygiene, prioritizing coverage for Staphylococcus aureus, including MRSA, as suggested by the most recent study 1.
Treatment Approach
For mild nasal vestibulitis, applying mupirocin (Bactroban) ointment inside the nostrils three times daily for 5-7 days can be effective. However, for more severe cases or abscesses, oral antibiotics that cover Staphylococcus aureus are necessary.
- Cephalexin (Keflex) 500mg four times daily for 7-10 days can be used for cases where MRSA is less likely.
- Clindamycin 300mg three times daily for 7-10 days is preferred if MRSA is suspected, given its efficacy against MRSA as shown in studies 2, 3.
- Trimethoprim-sulfamethoxazole is another option, especially considering its effectiveness against MRSA pneumonia 4, though its use in nasal vestibulitis and abscesses should be guided by culture results and susceptibility patterns.
Additional Measures
- Apply warm compresses to the affected area for 15-20 minutes several times daily to help reduce pain and promote drainage.
- Avoid nose picking and maintain good hand hygiene to prevent reinfection.
- If an abscess is present, it may require incision and drainage by a healthcare provider.
Importance of Prompt Treatment
These infections require prompt treatment as they occur in the "danger triangle" of the face, where infections can potentially spread to the brain. If symptoms worsen despite treatment, fever develops, or there is significant swelling or redness spreading beyond the nose, seek immediate medical attention as this could indicate a more serious infection requiring intravenous antibiotics. The choice of antibiotic should be guided by the most recent and highest quality evidence available, prioritizing patient outcomes in terms of morbidity, mortality, and quality of life 1.