From the Guidelines
The recommended treatment for purulent skin infections typically involves incision and drainage (I&D) as the primary intervention, especially for abscesses, as stated in the 2011 guidelines by the Infectious Diseases Society of America 1. For mild infections, I&D alone may be sufficient. For moderate infections, oral antibiotics active against methicillin-resistant Staphylococcus aureus (MRSA) should be added, such as:
- trimethoprim-sulfamethoxazole (TMP-SMX) at a dose of 1-2 double-strength tablets twice daily for 5-10 days
- clindamycin 300-450 mg four times daily for 5-10 days
- doxycycline 100 mg twice daily for 5-10 days Severe infections require intravenous antibiotics like vancomycin 15-20 mg/kg every 8-12 hours, linezolid 600 mg twice daily, or daptomycin 4 mg/kg daily, as recommended in the guidelines 1. Patients should keep the area clean, apply warm compresses to help with drainage, and take the full course of antibiotics even if symptoms improve quickly. These treatments target the most common causative organisms, particularly Staphylococcus aureus and Streptococcus species, with MRSA being increasingly prevalent in community-acquired skin infections. The purulence indicates an active bacterial infection with pus formation, which is why drainage is essential to remove the collection of bacteria, dead neutrophils, and tissue debris that comprise the pus. More recent guidelines from 2021 also support the use of short-course antibiotics for common infections, including skin and soft tissue infections, with a recommended course of 5 to 6 days for nonpurulent cellulitis 1. However, the 2011 guidelines by the Infectious Diseases Society of America remain the most relevant and comprehensive for the treatment of purulent skin infections, including abscesses and purulent cellulitis 1.
Some key points to consider in the treatment of purulent skin infections include:
- Incision and drainage is the primary treatment for cutaneous abscesses
- Antibiotic therapy is recommended for abscesses associated with severe or extensive disease, systemic illness, or lack of response to incision and drainage alone
- Empirical therapy for CA-MRSA is recommended for outpatients with purulent cellulitis
- Oral antibiotic options for empirical coverage of CA-MRSA include clindamycin, TMP-SMX, doxycycline, and linezolid
- Hospitalized patients with complicated SSTI may require intravenous antibiotics and surgical debridement.
Overall, the treatment of purulent skin infections requires a comprehensive approach that includes incision and drainage, antibiotic therapy, and supportive care to manage symptoms and prevent complications.
From the FDA Drug Label
- 3 Skin and Skin Structure Infections Piperacillin and Tazobactam for Injection is indicated in adults for the treatment of uncomplicated and complicated skin and skin structure infections, including cellulitis, cutaneous abscesses and ischemic/diabetic foot infections caused by beta-lactamase producing isolates of Staphylococcus aureus. The recommended treatment for purulent skin infections is piperacillin-tazobactam (IV), which is indicated for the treatment of complicated skin and skin structure infections, including cutaneous abscesses caused by beta-lactamase producing isolates of Staphylococcus aureus 2.
- The usual total daily dosage is 3.375 grams every six hours [totaling 13.5 grams (12.0 grams piperacillin and 1.5 grams tazobactam)], to be administered by intravenous infusion over 30 minutes.
- The usual duration of treatment is from 7 to 10 days.
From the Research
Treatment for Purulent Skin Infections
The recommended treatment for purulent skin infections involves the use of antibiotics, with the specific choice depending on the severity of the infection, local susceptibility patterns, and drug-related safety, tolerability, and cost 3.
- Antibiotic Options:
- Cephalexin is an effective antibiotic for the treatment of streptococcal and staphylococcal skin infections, with cure rates of 90% or higher 4.
- Penicillin remains the drug of choice for streptococcal skin infections, but cephalexin and other alternative antibiotics may be used if penicillin is not effective 4.
- For methicillin-resistant Staphylococcus aureus (MRSA) infections, vancomycin or teicoplanin may be used, while for less serious MRSA infections, lincosamides or cotrimoxazole may be effective 5.
- Other antibiotics such as clindamycin, erythromycin, and amoxicillin/clavulanic acid may also be used to treat purulent skin infections 6.
Severity of Infection
- Mild Infections: Topical antibiotics may be sufficient for mild and localized impetigo, while systemic antibiotics such as cloxacillin, erythromycin, or cephalexin may be needed for more widespread or severe infections 6.
- Severe Infections: Intravenous antibiotics such as penicillinase-resistant anti-staphylococcal antibiotics or vancomycin may be required for severe infections such as staphylococcal scalded skin syndrome or gangrenous cellulitis 6, 3.
Duration of Treatment
- Treatment Duration: The duration of treatment for purulent skin infections is typically 5 to 7 days, although this may vary depending on the severity of the infection and the response to therapy 3.