What antibiotic is used to treat a pilonidal (pilonidal) cyst?

From the Guidelines

For a pilonidal cyst infection, the recommended antibiotic treatment is amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days, as it provides broad-spectrum coverage against common skin flora, including Staphylococcus, Streptococcus, and anaerobes 1.

Key Considerations

• The choice of antibiotic should be based on the severity of the infection and the patient's medical history, including any allergies or previous antibiotic use.
• Alternatives to amoxicillin-clavulanate may include trimethoprim-sulfamethoxazole, clindamycin, or doxycycline, but these should be selected based on specific patient factors and potential resistance patterns 1.

Treatment Approach

• Antibiotics alone are usually insufficient for definitive treatment of pilonidal cyst infections, and most cases require drainage (incision and drainage procedure) along with antibiotic therapy.
• Proper wound care, including regular cleaning and dressing changes, is essential after drainage to promote healing and prevent further infection.
• For recurrent or complex pilonidal disease, surgical intervention may be necessary to achieve complete resolution.

Adjusting Treatment

• Antibiotic therapy should be adjusted based on culture results if available, to ensure the most effective treatment against the specific pathogens involved 1.
• Patients should complete the full course of antibiotics even if symptoms improve quickly, to minimize the risk of recurrence or development of antibiotic resistance.

From the FDA Drug Label

Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylocci... Serious skin and soft tissue infections The antibiotic clindamycin can be used to treat serious skin and soft tissue infections, which may include a pilonidal cyst, if caused by susceptible bacteria 2.

From the Research

Antibiotic Treatment for Pilonidal Cysts

• There is no direct mention of a specific antibiotic used to treat pilonidal cysts in the provided studies 3, 4, 5, 6, 7.
• However, the study 4 mentions that antibiotic prophylaxis is necessary in patients scheduled for Karydakis flap repair, and that triclosan-coated sutures tend to be associated with a lower rate of infection.
• The study 7 discusses the treatment of hidradenitis suppurativa, a different condition, but mentions the use of oral antibiotics as a treatment option.
• The study 5 presents a case series of patients with mild pilonidal disease managed with improved hygiene, pit excision, and laser epilation, without mentioning the use of antibiotics.
• The study 6 provides general information about pilonidal disease, but does not specify the use of antibiotics for treatment.
• The study 4 does mention that methicillin-susceptible coagulase-negative staphylococci were the most common isolates (30%) and the most frequently detected anaerobic micro-organism was Actinomyces israelii (7.5%), but does not recommend a specific antibiotic for treatment.

Summary of Findings

• The provided studies do not recommend a specific antibiotic for the treatment of pilonidal cysts.
• Antibiotic prophylaxis is recommended for patients undergoing Karydakis flap repair 4.
• Further research is needed to determine the most effective antibiotic treatment for pilonidal cysts.