From the FDA Drug Label
Vancomycin Hydrochloride for Injection, USP is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (β-lactam-resistant) staphylococci It is indicated for penicillin-allergic patients, for patients who cannot receive or who have failed to respond to other drugs, including the penicillins or cephalosporins, and for infections caused by vancomycin-susceptible organisms that are resistant to other antimicrobial drugs
The best antibiotic for a Bartholin's cyst with an allergy to clindamycin and failed treatment with Keflex is not directly stated in the provided drug label. However, vancomycin may be considered for patients who have failed to respond to other drugs, including cephalosporins like Keflex, but its effectiveness for Bartholin's cyst is not explicitly mentioned 1.
- Key considerations:
- The patient's allergy to clindamycin
- Failure of treatment with Keflex (Cephalexin)
- Potential use of vancomycin for severe or serious infections caused by susceptible strains of methicillin-resistant staphylococci It is crucial to determine the causative organisms and their susceptibilities to vancomycin before initiating treatment.
From the Research
For a Bartholin's cyst with allergies to clindamycin and failed treatment with Keflex, cefteram pivoxil (CFTM-PI) 300 mg/day, t.i.d. for 7 days, would be a good alternative antibiotic choice, as it has shown efficacy in treating Bartholin's gland abscesses caused by various pathogens, including Streptococcus pneumoniae and Haemophilus influenzae 2. This recommendation is based on the most recent and highest quality study available, which demonstrated the effectiveness of cefteram pivoxil in treating Bartholin's gland abscesses. Some key points to consider when treating a Bartholin's cyst include:
- The use of broad-spectrum antibiotics, such as cefteram pivoxil, which can cover a range of potential pathogens, including aerobic and anaerobic organisms.
- The importance of surgical drainage, such as marsupialization or placement of a Word catheter, in addition to antibiotic therapy, especially for recurrent or large cysts.
- The need for prompt reevaluation and potential adjustment of antibiotic therapy if symptoms worsen despite treatment.
- The use of comfort measures, such as warm sitz baths, to help alleviate symptoms during treatment. It's also important to note that the management of Bartholin's cysts and gland abscesses can be challenging, and treatment options may vary depending on the individual case and the presence of any underlying conditions or allergies 3, 4, 5. In general, the choice of antibiotic should be guided by the most recent and highest quality evidence available, and should take into account the potential risks and benefits of each option, as well as any relevant patient factors, such as allergies or underlying medical conditions 6.