From the Guidelines
Antibiotic treatment is generally not recommended for most simple, drained abscesses, but may be indicated in specific situations such as extensive cellulitis, systemic symptoms, immunocompromised patients, or abscesses in critical locations. The primary treatment for an abscess is incision and drainage, as the removal of purulent material is typically sufficient for resolution 1. However, in certain cases, antibiotics may be necessary to prevent further complications.
When antibiotics are needed, empiric coverage should target Staphylococcus aureus, including MRSA. Common regimens include:
- Trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily for 5-10 days
- Doxycycline 100mg twice daily for 5-10 days
- Clindamycin 300-450mg four times daily for 5-10 days
The choice of antibiotic depends on local resistance patterns and patient factors such as allergies and comorbidities 1. It is essential to note that antibiotics cannot effectively penetrate the avascular environment of an undrained abscess, which is why drainage is the primary treatment. Patients should complete the full course of antibiotics if prescribed, keep the wound clean, and follow up if symptoms worsen or do not improve within 48-72 hours.
In patients with anorectal abscess, antibiotics administration is suggested in the presence of sepsis and/or surrounding soft tissue infection or in case of disturbances of the immune response 1. Sampling of drained pus is recommended in high-risk patients and/or in cases with risk factors for multidrug-resistant organism infection. The WSES guidelines for soft-tissue and intra-abdominal infections provide a discussion of the appropriate antibiotics regimens 1.
In summary, while antibiotic treatment is not always necessary for drained abscesses, it may be indicated in specific situations, and the choice of antibiotic should be based on local resistance patterns and patient factors. The most recent and highest quality study, published in 2021, suggests that an empiric 5–10 day course of antibiotics following operative drainage may reduce the incidence of post-operative fistula 1.
From the Research
Antibiotic Treatment for Drained Abscess
The recommended antibiotic treatment for a drained abscess can vary depending on the causative organism and the patient's individual circumstances.
- For methicillin-resistant Staphylococcus aureus (MRSA) infections, vancomycin remains an acceptable treatment option 2.
- Combination therapy with vancomycin and ceftaroline may be considered for patients with persistent MRSA bacteremia refractory to initial therapy 3.
- Vancomycin combined with clindamycin may be effective for the treatment of acute bacterial skin and skin-structure infections, including those with abscesses 4.
- However, some studies suggest that incision and drainage (I&D) alone may be sufficient for the treatment of uncomplicated abscesses, without the need for post-procedural antibiotics 5, 6.
Considerations for Antibiotic Use
- The use of antibiotics should be considered on a case-by-case basis, taking into account the patient's individual risk factors and the presence of high-risk features such as immunocompromisation or positive wound cultures for MRSA 5.
- There is no compelling evidence for routine cultures or empiric treatment with antibiotics in immunocompetent patients with no confounding risk factors 6.
- The choice of antibiotic should be guided by the results of culture and sensitivity testing, where possible 2, 4.