From the Guidelines
The recommended treatment for a 2cm gluteal abscess is incision and drainage (I&D), which should be performed as soon as possible. This procedure involves making an incision over the abscess, evacuating the purulent material, breaking up any loculations, and leaving the wound open to heal by secondary intention 1. Local anesthesia with 1% lidocaine (avoiding epinephrine) is typically sufficient, though deeper or more painful abscesses may require procedural sedation. After drainage, the cavity should be packed loosely with plain gauze that should be changed daily until the wound heals from the inside out.
Key Considerations
- Antibiotics are not routinely required after successful drainage unless the patient has systemic symptoms (fever, elevated white blood cell count), surrounding cellulitis, immunocompromise, or is at risk for endocarditis 1.
- When antibiotics are indicated, options include trimethoprim-sulfamethoxazole (one double-strength tablet twice daily), clindamycin (300-450mg four times daily), or doxycycline (100mg twice daily) for 5-7 days to cover MRSA 1.
- Warm compresses applied to the area several times daily can help with healing and pain relief.
- Patients should be advised to return if symptoms worsen, fever develops, or if the abscess recurs, as recurrent gluteal abscesses may indicate an underlying condition requiring further evaluation.
Additional Guidance
- The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended 1.
- For empirical coverage of CA-MRSA in outpatients with SSTI, oral antibiotic options include clindamycin, TMP-SMX, a tetracycline (doxycycline or minocycline), and linezolid 1.
From the Research
Treatment of Gluteal Abscess
- The recommended treatment for a gluteal abscess is incision and drainage (I&D) 2, 3.
- For a 2cm gluteal abscess, I&D can be performed, but there is no specific evidence to suggest that packing the wound or using post-procedural antibiotics is necessary for small abscesses 2, 3.
- However, if the abscess is large (greater than 5cm), packing the wound may reduce recurrence and complications 2.
- It is also important to consider the patient's overall health and the presence of any underlying conditions that may affect the treatment of the abscess 4, 5.
- In some cases, antibiotics may be necessary, especially if the abscess is caused by a bacteria such as Staphylococcus aureus, including methicillin-resistant S aureus (MRSA) 3, 6.
- The choice of antibiotic should be based on the severity of the infection, local susceptibility patterns, and drug-related safety, tolerability, and cost 6.