From the Guidelines
The first-line treatment for a purulent wound on the buttock is incision and drainage (I&D), followed by appropriate antibiotic therapy. For a typical abscess, the clinician should make an adequate incision over the fluctuant area, break up any loculations, and drain all purulent material 1. After drainage, the wound should be packed loosely with gauze to allow continued drainage.
Key Considerations
- Empiric antibiotic therapy should include coverage for methicillin-resistant Staphylococcus aureus (MRSA), with options including trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily, doxycycline 100 mg twice daily, or clindamycin 300-450 mg four times daily for 5-10 days 1.
- The wound should be cleaned daily with saline or mild soap and water, with packing changes as needed until the wound begins to heal from the base upward.
- Warm compresses can help improve blood flow to the area and promote healing.
Antibiotic Therapy
- For outpatients with purulent cellulitis, empirical therapy for CA-MRSA is recommended pending culture results 1.
- For empirical coverage of CA-MRSA in outpatients with SSTI, oral antibiotic options include clindamycin, TMP-SMX, a tetracycline (doxycycline or minocycline), and linezolid 1.
Important Notes
- Cultures from abscesses and other purulent SSTIs are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak 1.
- The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended 1.
From the Research
First-Line Treatment for Purulent Wound on the Buttock
The first-line treatment for a purulent wound on the buttock involves several key steps to promote healing and prevent further infection.
- Evaluation of the wound severity to determine the appropriate course of action 2
- Cleansing the wound with serum or water after washing hands, followed by wound disinfection with an appropriate antiseptic 2
- Removal of all inorganic residues, dead tissue, detritus, slough, purulent exudate, and scabs to aid healing and the action of antiseptics 2
- Debridement, which is the removal of necrotic material, scabs, devitalized tissues, and other impurities that delay wound healing 3
- Use of advanced dressings, such as hydrophilic coatings, chitosan, collagen, methylcellulose, and its derivatives, which have higher efficacy in wound healing 4
- Consideration of vacuum sealing drainage (VSD) as a therapeutic concept to achieve secure and rapid wound healing in severe cases 5
Debridement Techniques
Debridement is an essential element of wound healing therapy, and various techniques are available, including:
- Surgical debridement
- Autolytic debridement
- Enzymatic debridement
- Mechanical debridement
- Biosurgical debridement The selection of the most appropriate debridement technique depends on factors such as tissue type, presence of biofilm, depth and location of the wound, underlying cause, and patient preferences 3
Wound Dressings
Wound dressings play a crucial role in the local management of purulent wounds.
- Hydrophilic coatings and coatings based on chitosan, collagen, methylcellulose, and its derivatives are preferred due to their higher efficacy 4
- Introduction of antiseptic substances with fewer side effects compared to antibiotics is advisable 4
- Further research and development of new wound dressings are necessary to address the changing landscape of microorganism resistance 4