From the Guidelines
The treatment for a 55-year-old male with a 3mm periosteal abscess with cellulitis on facial CT scan should include immediate antibiotic therapy and possible surgical drainage. I recommend starting with empiric broad-spectrum antibiotics such as Augmentin (amoxicillin-clavulanate) 875/125mg orally twice daily, or if more severe, intravenous ampicillin-sulbactam 3g every 6 hours, as suggested by the guidelines for the treatment of skin and soft tissue infections 1. For patients with penicillin allergy, clindamycin 300-450mg orally four times daily or 600-900mg IV every 8 hours is appropriate, as it provides coverage for both b-hemolytic streptococci and CA-MRSA 1. Treatment duration should be 10-14 days. The patient should be evaluated by an otolaryngologist or oral-maxillofacial surgeon for possible incision and drainage, especially if the abscess is fluctuant or if there's no improvement within 24-48 hours of antibiotic therapy, as surgical drainage is usually appropriate for infected fluid collections 1. Pain management with acetaminophen or NSAIDs is also recommended. Close follow-up within 48-72 hours is essential to assess treatment response. This aggressive approach is necessary because facial abscesses can rapidly progress to more serious complications including cavernous sinus thrombosis, meningitis, or intracranial abscess due to the rich vascular supply of the face and proximity to critical structures. Key considerations in the management of this patient include:
- The need for prompt antibiotic therapy and possible surgical drainage
- The importance of coverage for both b-hemolytic streptococci and CA-MRSA
- The potential for serious complications if the infection is not adequately managed
- The need for close follow-up to assess treatment response and adjust the management plan as needed.
From the FDA Drug Label
Vancomycin Hydrochloride for Injection, USP is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (β-lactam-resistant) staphylococci Vancomycin Hydrochloride for Injection, USP is effective in the treatment of staphylococcal endocarditis Its effectiveness has been documented in other infections due to staphylococci, including septicemia, bone infections, lower respiratory tract infections, skin and skin structure infections. When staphylococcal infections are localized and purulent, antibiotics are used as adjuncts to appropriate surgical measures
The treatment for a 55-year-old male with a computed tomography (CT) scan of the face showing a 3mm periosteal abscess with cellulitis may include vancomycin as an option, considering its effectiveness in treating skin and skin structure infections caused by susceptible strains of staphylococci 2.
- Surgical measures may also be necessary as an adjunct to antibiotic treatment for localized and purulent infections.
- It is essential to obtain specimens for bacteriologic cultures to determine the causative organisms and their susceptibilities to vancomycin.
SKIN AND SKIN STRUCTURE INFECTIONS Caused by Staphylococcus aureus, Staphylococcus epidermidis, Ceftriaxone for Injection has also been used successfully in a limited number of cases of meningitis and shunt infection caused by Staphylococcus epidermidis
Ceftriaxone may also be considered as a treatment option for skin and skin structure infections caused by Staphylococcus aureus or Staphylococcus epidermidis 3.
- However, the choice of antibiotic should be based on the results of bacteriologic cultures and susceptibility testing.
From the Research
Treatment for Periosteal Abscess with Cellulitis
- The treatment for a 55-year-old male with a computed tomography (CT) scan of the face showing a 3mm periosteal abscess with cellulitis involves addressing the infection and its cause.
- According to 4, empirical antibiotic treatment should include vancomycin or daptomycin, which are active against MRSA.
- Source control is a critical component of treating infections and may include removal of infected devices, drainage of abscesses, and surgical debridement 4.
- For methicillin-susceptible Staphylococcus aureus (MSSA) infections, cefazolin or antistaphylococcal penicillins can be used 4.
- Studies have shown that ceftriaxone is a safe and effective alternative for the treatment of MSSA infections, with a lower risk of toxicity compared to antistaphylococcal antibiotics 5, 6.
- Ceftriaxone has also been shown to be effective in the treatment of open fractures, with no increase in infectious complications 7, 8.
Antibiotic Treatment Options
- Vancomycin or daptomycin for empirical treatment of MRSA 4
- Cefazolin or antistaphylococcal penicillins for MSSA infections 4
- Ceftriaxone as an alternative for MSSA infections, with a lower risk of toxicity 5, 6