What antibiotic is recommended for a soft tissue infected cyst?

From the Guidelines

For a soft tissue infected cyst, the primary treatment should be incision and drainage, and antibiotic therapy is recommended for severe or extensive disease, or when there are signs of systemic illness, comorbidities, or immunosuppression, with clindamycin being a suitable option for empirical coverage of CA-MRSA and b-hemolytic streptococci 1. When considering antibiotic treatment for a soft tissue infected cyst, it's essential to note that incision and drainage is the primary treatment, especially for cutaneous abscesses or boils, as stated in the clinical practice guidelines by the Infectious Diseases Society of America 1.

Key Considerations

• The choice of antibiotic should target common pathogens such as Staphylococcus aureus and Streptococcus species.
• For empirical coverage of CA-MRSA, oral antibiotic options include clindamycin, TMP-SMX, a tetracycline (doxycycline or minocycline), and linezolid, with clindamycin being a suitable option for coverage of both b-hemolytic streptococci and CA-MRSA 1.
• The duration of therapy should be individualized based on the patient's clinical response, but typically ranges from 5 to 10 days for outpatients and 7 to 14 days for hospitalized patients with complicated SSTI.

Treatment Approach

• Before starting antibiotics, the infected cyst should ideally be incised and drained if fluctuant, as antibiotics alone may be insufficient without drainage.
• Patients should be advised to take the full course of antibiotics even if symptoms improve quickly, keep the area clean, and seek follow-up care if the infection worsens, spreads, or doesn't improve within 48-72 hours of treatment.
• If MRSA is suspected based on local prevalence or patient risk factors, consider alternative antibiotic options such as trimethoprim-sulfamethoxazole or doxycycline, as recommended in the guidelines 1.

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 respiratory tract infections such as empyema, anaerobic pneumonitis, and lung abscess; serious skin and soft tissue infections; Streptococci: Serious respiratory tract infections; serious skin and soft tissue infections. Staphylococci: Serious respiratory tract infections; serious skin and soft tissue infections.

Clindamycin can be used to treat serious skin and soft tissue infections, including those caused by anaerobes, streptococci, and staphylococci. However, bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin. The use of clindamycin should be reserved for cases where it is strongly suspected to be caused by susceptible bacteria 2.

• Key points:
  • Clindamycin is indicated for serious skin and soft tissue infections.
  • Bacteriologic studies are necessary to determine susceptibility.
  • Use clindamycin only when strongly suspected to be caused by susceptible bacteria.

From the Research

Antibiotic Treatment for Soft Tissue Infected Cyst

• Cephalexin is an effective antibiotic for the treatment of streptococcal and staphylococcal skin and soft-tissue infections, with cure rates of 90% or higher 3.
• It is comparable to other antibiotics such as erythromycin, clindamycin, dicloxacillin, and cloxacillin in the treatment of these infections 3.
• Doxycycline may also be a reasonable therapeutic alternative for the treatment of presumed streptococcal skin and soft tissue infection, especially in regions with low tetracycline resistance 4.
• The choice of antibiotic may depend on cost factors, as many antibiotics are similar in efficacy, palatability, and adverse reactions 3.

Treatment of Soft Tissue Infections

• Treatment of soft tissue infections starts with prompt identification and eradication of infection, including antibiotics and extensive debridement 5.
• Optimizing the patient's medical and nutritional status can facilitate eradication of infection and wound healing 5.
• Coverage of soft tissue defects caused by infection and debridement demands consideration of many factors, including healing by primary or secondary intention, skin grafts, local flaps, and distant flaps 5.

Evaluation and Treatment of Soft Tissue Masses

• Soft tissue masses, including cysts, should be evaluated to determine if they are benign or malignant 6.
• Imaging studies such as ultrasonography, radiography, and magnetic resonance imaging with contrast may be used to assess the size, depth, and nature of the mass 6.
• Incisional biopsy of a concerning soft tissue mass can be useful for establishing a diagnosis, and referral to orthopedic oncology may be necessary for high-risk masses 6.