What is the antibiotic of choice for a pilonidal (pilonidal sinus) cyst infection?

From the Guidelines

For pilonidal cyst infections, the recommended first-line antibiotic therapy is typically a broad-spectrum antibiotic with coverage against skin flora, particularly Staphylococcus and anaerobes, with amoxicillin-clavulanate (875/125 mg orally twice daily for 7-10 days) being a preferred choice, as suggested by general medical knowledge and guidelines for skin and soft tissue infections 1. The choice of antibiotic is crucial in managing pilonidal cyst infections, considering the polymicrobial nature of these infections. Key factors influencing this choice include the antibiotic's ability to penetrate skin and soft tissues, its coverage of common pathogens such as Staphylococcus and anaerobes, and the patient's allergy profile.

• Amoxicillin-clavulanate is often preferred due to its broad-spectrum coverage and effectiveness against both aerobic and anaerobic bacteria.
• Alternatives for patients with penicillin allergies or for those requiring additional anaerobic coverage include trimethoprim-sulfamethoxazole (TMP-SMX) plus metronidazole, or clindamycin, as these regimens also provide adequate coverage against the typical pathogens involved in pilonidal cyst infections 1. However, it's essential to note that antibiotics alone are generally insufficient for the treatment of pilonidal disease.
• Incision and drainage are the primary treatments for acute abscesses, with antibiotics serving as adjunctive therapy to manage or prevent infection.
• For recurrent or complex pilonidal disease, definitive surgical management is typically necessary to address the underlying cause and prevent further recurrences. Good hygiene practices, including keeping the area clean and dry, are essential adjuncts to antibiotic therapy, helping to prevent the spread of infection and promote healing. The guidelines for the diagnosis and management of skin and soft tissue infections support the use of antibiotics in conjunction with other treatments for conditions like pilonidal cyst infections 1.

From the Research

Antibiotic Treatment for Pilonidal Cyst Infection

• The antibiotic of choice for a pilonidal cyst infection is not explicitly stated in the provided studies, but one study mentions the use of oral cefalexin and metronidazole for 7 days after aspiration of a pilonidal abscess 2.
• This treatment was found to be effective in 83% of patients, with high overall satisfaction rates and low recurrence rates.
• The use of antibiotics in combination with surgical treatment or aspiration may be beneficial in reducing the risk of infection and promoting healing.

Surgical Treatment and Wound Management

• Surgical treatment is the principal method of treatment for pilonidal cysts, with various techniques available, including excision, incision and curettage, and flap procedures 3, 4, 5.
• Post-surgical wound management is crucial to prevent complications and promote healing, with techniques such as rinsing with antimicrobial solutions, applying haemoglobin spray, and using appropriate dressings 6.
• The choice of surgical technique and wound management strategy may depend on the individual patient's needs and the severity of the disease.

Treatment Outcomes and Recurrence Rates

• The Bascom cleft-lift procedure has been shown to have a low recurrence rate and fast healing time, making it a preferred surgical treatment for patients with pilonidal disease in a chronic phase 3.
• The Limberg flap procedure has also been found to have a low recurrence rate and good cosmetic results, making it a viable option for treatment 5.
• Aspiration of a pilonidal abscess followed by antibiotics has been shown to be effective in reducing the need for surgical incision and drainage, with high patient satisfaction rates 2.