From the Research
For a recurrent gluteal infection that did not respond to terbinafine, I recommend a comprehensive approach starting with proper diagnosis through culture and sensitivity testing to identify the specific pathogen. The most effective treatment likely involves a combination of oral antibiotics such as trimethoprim-sulfamethoxazole (Bactrim DS, 1-2 tablets twice daily for 7-10 days) or clindamycin (300-450 mg four times daily for 7-10 days), along with topical antibiotics like mupirocin 2% ointment applied three times daily. For deep or abscess-forming infections, incision and drainage may be necessary. Good hygiene practices are essential, including daily washing with antibacterial soap, wearing loose cotton underwear, and changing clothes after sweating. Terbinafine is primarily an antifungal medication, so its ineffectiveness suggests the infection may be bacterial rather than fungal in nature. Staphylococcus aureus, including MRSA, is a common cause of recurrent skin infections in this area. For truly recurrent infections, decolonization protocols may be needed, including chlorhexidine washes and intranasal mupirocin for 5-7 days to eliminate bacterial reservoirs.
Key Considerations
- The infection may be bacterial rather than fungal in nature, given terbinafine's ineffectiveness 1, 2.
- Staphylococcus aureus, including MRSA, is a common cause of recurrent skin infections in this area 3.
- Decolonization protocols may be necessary for truly recurrent infections, including chlorhexidine washes and intranasal mupirocin for 5-7 days to eliminate bacterial reservoirs.
- Culture and sensitivity testing is crucial to identify the specific pathogen and guide antibiotic therapy 3.
Treatment Options
- Oral antibiotics: trimethoprim-sulfamethoxazole (Bactrim DS, 1-2 tablets twice daily for 7-10 days) or clindamycin (300-450 mg four times daily for 7-10 days) 3.
- Topical antibiotics: mupirocin 2% ointment applied three times daily.
- Incision and drainage for deep or abscess-forming infections.
- Good hygiene practices, including daily washing with antibacterial soap, wearing loose cotton underwear, and changing clothes after sweating.
Supporting Evidence
The study by 3 highlights the importance of identifying the specific pathogen and using appropriate antibiotic therapy, and the study by 2 suggests that terbinafine may not be effective in treating all types of fungal infections, which may lead to consideration of bacterial causes.