What are the discharge instructions for a patient with a pilonidal abscess prescribed doxycycline (antibiotic) after urgent care visit?

From the Guidelines

After a pilonidal abscess treatment, take doxycycline exactly as prescribed, typically 100mg twice daily for 7-10 days, completing the entire course even if you feel better, as recommended by recent guidelines 1. The most recent and highest quality study, published in 2021, suggests that antibiotic administration is recommended in the presence of sepsis and/or surrounding soft tissue infection or in case of disturbances of the immune response 1. Key points to follow after treatment include:

• Keeping the wound clean by showering daily and gently cleaning the area with mild soap and water, then patting dry
• Changing dressings as instructed, usually 1-2 times daily
• Sitting on soft surfaces and avoiding prolonged sitting when possible
• Watching for signs of worsening infection including increased pain, redness, swelling, fever, or foul-smelling drainage
• Taking over-the-counter pain relievers like acetaminophen or ibuprofen as needed for discomfort
• Avoiding shaving the area until fully healed
• Returning for follow-up as scheduled, typically within 1-2 weeks It is essential to note that doxycycline works by preventing bacterial growth and reducing inflammation in the infected area, and patients should call their healthcare provider if symptoms worsen or they experience side effects from the medication such as severe stomach upset, rash, or difficulty breathing. Additionally, the use of imaging investigations, such as MRI, CT scan, or endosonography, may be suggested in case of atypical presentation and in case of suspicion of occult supralevator abscesses, complex anal fistula, or perianal Crohn’s disease 1. The timing of surgery should be based on the presence and severity of sepsis, and in fit, immunocompetent patients with a small perianal abscess and without systemic signs of sepsis, outpatient management may be considered 1.

From the Research

Discharge Instructions for Pilonidal Abscess

Overview

The patient has been diagnosed with a pilonidal abscess and prescribed doxycycline after an urgent care visit. The following discharge instructions are based on available evidence:

• The patient should take the prescribed doxycycline as directed to ensure proper healing and prevent infection [ 2, 3 ].
• It is essential to keep the wound clean and dry to promote healing and prevent further infection.
• The patient should follow up with their healthcare provider to monitor the healing progress and address any concerns.

Wound Care

• The patient should gently clean the wound with mild soap and water [ 4 ].
• Apply a topical agent or dressing as recommended by the healthcare provider to promote wound healing [ 4 ].
• Change the dressing regularly to keep the wound clean and dry.

Activity Level

• The patient can resume normal activities as soon as they feel comfortable [ 2, 3 ].
• Avoid heavy lifting, bending, or strenuous activities that may exacerbate the condition.

Follow-up Care

• Schedule a follow-up appointment with the healthcare provider to monitor the healing progress [ 2, 3, 5 ].
• Report any signs of infection, such as increased redness, swelling, or discharge, to the healthcare provider immediately.

Additional Considerations

• The patient may experience some discomfort or pain during the healing process [ 3 ].
• Over-the-counter pain medication can be taken as directed to manage pain and discomfort.
• If the patient has any questions or concerns, they should contact their healthcare provider for guidance.