From the Guidelines
For most uncomplicated skin abscesses in adults, antibiotics may not be necessary after adequate incision and drainage (I&D), but when indicated, trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets (160mg/800mg) twice daily for 5-10 days is a recommended first-line regimen. This recommendation is based on the most recent and highest quality study available, which provides guidance on the management of skin and soft tissue infections, including abscesses 1. The study suggests that antibiotics are not always necessary after I&D, but may be indicated in certain situations, such as systemic symptoms, extensive disease, or risk factors.
Some key points to consider when deciding on antibiotic therapy for an adult with an abscess after I&D include:
- The presence of systemic inflammatory response syndrome (SIRS), such as temperature >38°C or <36°C, tachypnea >24 breaths per minute, tachycardia >90 beats per minute, or white blood cell count >12 000 or <400 cells/µL 1
- The presence of risk factors, such as immunosuppression, or abscesses in sensitive areas, such as the face, hand, or genitalia 1
- The need for adequate drainage of the abscess, as this remains the primary treatment, and antibiotics alone without proper drainage are unlikely to resolve the infection completely 1
Alternative antibiotic regimens that may be considered include:
- Doxycycline 100mg twice daily
- Clindamycin 300-450mg four times daily
- Linezolid 600mg twice daily These antibiotics are recommended because they provide good coverage against methicillin-resistant Staphylococcus aureus (MRSA), which is a common cause of skin abscesses 1. Patients should be advised to complete the full course of antibiotics even if symptoms improve quickly, and to seek medical attention if symptoms worsen or fail to improve within 48 hours.
From the Research
Antibiotic Regimens for Adults with Abscesses after I&D
The recommended antibiotic regimen for an adult with an abscess after incision and drainage (I&D) is a topic of ongoing debate.
- Studies have shown that the use of antibiotics after I&D may not be necessary for uncomplicated skin and soft tissue abscesses 2.
- However, some studies suggest that antibiotics may be beneficial in certain cases, such as in patients with high-risk features or those with positive wound cultures for MRSA 3.
- Commonly prescribed antibiotics for abscesses include trimethoprim-sulfamethoxazole, cephalexin, and clindamycin 4.
- Minocycline has also been shown to be effective in treating community-acquired MRSA skin and soft-tissue infections 5.
Factors Influencing Antibiotic Choice
The choice of antibiotic regimen may depend on various factors, including:
- The presence of high-risk features, such as immunocompromised status or positive wound cultures for MRSA 3.
- The size and location of the abscess 6.
- The patient's medical history and allergy profile.
Current Recommendations
Current recommendations suggest that antibiotics may not be necessary for uncomplicated skin and soft tissue abscesses after I&D 2.