What is the treatment for nasal abscess and cellulitis?

From the Guidelines

Nasal abscess and cellulitis treatment should prioritize incision and drainage, along with empiric antibiotic therapy covering Staphylococcus aureus (including MRSA) and streptococci, as recommended by the Infectious Diseases Society of America 1.

Key Considerations

• The primary treatment for a cutaneous abscess, including nasal abscess, is incision and drainage, which may be sufficient for simple cases, but additional antibiotic therapy may be necessary for more complex or severe infections 1.
• Antibiotic therapy is recommended for abscesses associated with severe or extensive disease, rapid progression, signs of systemic illness, or abscesses in areas difficult to drain, such as the face 1.
• Empiric antibiotic therapy for outpatients with purulent cellulitis should cover CA-MRSA, while for nonpurulent cellulitis, coverage for b-hemolytic streptococci is recommended, with optional coverage for CA-MRSA in certain cases 1.

Recommended Antibiotic Regimens

• For initial management, clindamycin 300-450mg orally four times daily or trimethoprim-sulfamethoxazole (TMP-SMX) DS 1-2 tablets twice daily plus cephalexin 500mg four times daily for 7-10 days can be considered 1.
• For more severe cases requiring hospitalization, intravenous options include vancomycin 15-20mg/kg every 12 hours or clindamycin 600-900mg every 8 hours 1.

Additional Treatment Measures

• Surgical drainage is necessary if the abscess is fluctuant or if there's no improvement after 24-48 hours of antibiotic therapy, with the procedure involving incision and drainage under local anesthesia and possible placement of a small drain or packing 1.
• Warm compresses and nasal saline irrigation can help improve circulation, reduce pain, and promote healing after the acute phase 1.

Importance of Prompt Treatment

• Nasal abscess and cellulitis require prompt treatment due to the risk of spreading to involve the cavernous sinus or intracranial structures, given the facial area's rich vasculature and connection to the "danger triangle" of the face 1.

From the Research

Nasal Abscess and Cellulitis Treatment

• The treatment for cellulitis typically involves a penicillin or cephalosporin, while the treatment of abscesses is incision and drainage 2.
• Loop drainage is preferred over the traditional incision and drainage technique, and adjunctive antibiotics can be considered 2.
• For nasal septal abscess and facial cellulitis caused by community-acquired methicillin-resistant Staphylococcus aureus, prompt diagnosis and appropriate medical and/or surgical management are essential 3.
• Empiric outpatient therapy with trimethoprim-sulfamethoxazole, cephalexin, or clindamycin can be effective for cellulitis, with trimethoprim-sulfamethoxazole having a higher treatment success rate than cephalexin 4.
• Antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, are preferred empiric therapy for outpatients with cellulitis in the community-associated MRSA-prevalent setting 4.
• The majority of non-purulent, uncomplicated cases of cellulitis are caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus, and appropriate targeted coverage of this pathogen with oral antibiotics such as penicillin, amoxicillin, and cephalexin is sufficient 5.
• Coverage for non-purulent cellulitis is generally not recommended, even with rising rates of community-acquired methicillin-resistant Staphylococcus aureus 5.
• The addition of trimethoprim-sulfamethoxazole to cephalexin did not improve outcomes overall or by subgroup in patients diagnosed with cellulitis without abscess 6.