What is the treatment for a recurrent abscess (collection of pus) on the back that has been previously drained and treated with doxycycline (doxy) and ciprofloxacin (cipro), now with pus rising to the surface again?

From the Guidelines

The recommended treatment for a recurrent abscess on the back that has previously been drained and treated with antibiotics is surgical incision and drainage (I&D) followed by culture-guided antibiotic therapy. You should see a healthcare provider promptly for proper drainage of the abscess, which involves making an incision to release the pus, cleaning the cavity, and possibly placing a wick or drain to allow continued drainage. After drainage, your provider should send a sample of the pus for culture and sensitivity testing to identify the specific bacteria causing the infection and determine which antibiotics will be most effective, as suggested by the Infectious Diseases Society of America guidelines 1. Given your previous treatment with doxycycline and ciprofloxacin without lasting resolution, you may need different antibiotics such as trimethoprim-sulfamethoxazole (Bactrim DS, typically 1 tablet twice daily for 7-10 days) or clindamycin (300-450 mg orally four times daily for 7-10 days), especially if MRSA (Methicillin-resistant Staphylococcus aureus) is suspected, according to the guidelines for treating MRSA infections 1.

Some key points to consider in the treatment of recurrent abscesses include:

• The importance of proper drainage and cleaning of the abscess cavity
• The need for culture and sensitivity testing to guide antibiotic therapy
• The potential for antibiotic resistance, particularly in cases of MRSA
• The consideration of underlying conditions that may be contributing to the recurrence of abscesses, such as hidradenitis suppurativa or pilonidal cyst, as noted in the 2014 update by the Infectious Diseases Society of America 1
• The use of preventive measures, such as daily chlorhexidine washes and warm compresses, to reduce the risk of recurrence and promote healing.

It's also important to note that recurrent abscesses can be a sign of an underlying issue, such as a neutrophil disorder, especially if they began in early childhood, as mentioned in the guidelines 1. Therefore, a thorough evaluation by a healthcare provider is necessary to determine the best course of treatment and to rule out any underlying conditions that may be contributing to the recurrence of abscesses.

From the FDA Drug Label

14 CLINICAL STUDIES 14. 1 Acute Bacterial Skin and Skin Structure Infections

Adults A total of 1333 adults with acute bacterial skin and skin structure infections (ABSSSI) were randomized in two multicenter, multinational, double-blind, non-inferiority trials. The types of ABSSSI included were cellulitis/erysipelas, wound infection, and major cutaneous abscess

The patient has a recurrent abscess on the back that has been previously drained and treated with doxycycline and ciprofloxacin. Treatment for this condition is not directly stated in the provided drug label, but it does mention the treatment of major cutaneous abscess with tedizolid (SIVEXTRO) in clinical trials 2. However, since the provided abscess is described as a small cabuncle/minor abscess, the information from the drug label may not be directly applicable. Given the recurrent nature of the abscess and the fact that it has risen to the surface again, it would be prudent to consider incision and drainage as part of the treatment, possibly alongside antibiotic therapy. The choice of antibiotic would depend on the suspected or confirmed causative pathogens and their susceptibility patterns. It is essential to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan.

From the Research

Treatment for Recurrent Abscess

• The patient has a recurrent abscess on the back that has been previously drained and treated with doxycycline and ciprofloxacin, now with pus rising to the surface again.
• The treatment for this condition is not clearly defined, but several studies suggest that antibiotics such as clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) may be effective in conjunction with incision and drainage 3, 4, 5, 6.
• A study published in The New England Journal of Medicine found that clindamycin or TMP-SMX in conjunction with incision and drainage improves short-term outcomes in patients with simple abscesses 3.
• Another study found that trimethoprim-sulfamethoxazole was superior to placebo in treating uncomplicated skin abscesses, with a higher cure rate and lower rates of subsequent surgical drainage procedures and skin infections at new sites 6.

Antibiotic Therapy

• The choice of antibiotic therapy is crucial in treating recurrent abscesses, and inadequate antibiotic coverage can result in higher recurrence rates 7.
• A study published in Surgical Infections found that inadequate antibiotic therapy after incision and drainage of complicated peri-rectal abscess resulted in a six-fold increase in the re-admission rate for abscess recurrence 7.
• The study suggests that a standard oral protocol combining antibiotics covering typical gram-positive, gram-negative, and anaerobic organisms should provide adequate coverage after surgical drainage 7.

Management

• The management of the patient's recurrent abscess should include incision and drainage, as well as antibiotic therapy with a broad-spectrum antibiotic such as clindamycin or TMP-SMX 3, 4, 5, 6.
• The patient should be closely monitored for signs of infection or recurrence, and adjustments to the antibiotic therapy should be made as needed based on culture and susceptibility results 7.