What is the follow-up care for a patient with an MRSA (Methicillin-resistant Staphylococcus aureus) abscess after treatment with Bactrim (trimethoprim/sulfamethoxazole) and clindamycin?

Follow-Up Care for MRSA Abscess After Bactrim and Clindamycin Treatment

After treatment with trimethoprim-sulfamethoxazole (TMP-SMX) and clindamycin for MRSA abscess, patients require clinical evaluation within 48-72 hours of starting treatment to assess response, followed by completion of the full antibiotic course (7-10 days for uncomplicated infections) and implementation of hygiene measures to prevent recurrence. 1

Immediate Post-Treatment Follow-Up

• Clinical evaluation at 48-72 hours after starting antibiotics to assess:

  • Resolution of fever
  • Reduction in pain, erythema, and swelling
  • Adequacy of drainage if incision and drainage was performed 1

• Complete the full antibiotic course (typically 7-10 days for uncomplicated infections, 7-14 days for complicated infections) 1

• Wound care management:

  • Keep draining wounds covered with clean, dry bandages
  • Change dressings regularly as they become soiled
  • Cleanse the wound with warmed sterile water, saline, or chlorhexidine
  • Apply appropriate dressings to maintain a moist wound environment 1

Prevention of Recurrence

Personal Hygiene Measures

• Regular bathing and cleaning hands with soap and water or alcohol-based hand gel, particularly after touching infected skin 2
• Avoid reusing or sharing personal items (razors, linens, towels) that have contacted infected skin 2

Environmental Hygiene Measures

• Focus cleaning on high-touch surfaces (counters, doorknobs, bathtubs, toilet seats) 2
• Use commercially available cleaners or detergents appropriate for the surface 2

Monitoring for Treatment Failure or Recurrence

• Signs of treatment failure requiring prompt medical attention:

  • Persistent or worsening fever
  • Increasing pain, erythema, or swelling
  • New or expanding areas of infection
  • Development of systemic symptoms 1

• Monitor for potential antibiotic side effects:

  • TMP-SMX: rash, bone marrow suppression
  • Clindamycin: diarrhea, Clostridioides difficile infection 1

Decolonization Strategies

Decolonization should be considered if:

• Patient develops recurrent MRSA skin infections despite optimizing wound care and hygiene
• Ongoing transmission among household members or close contacts 2

Decolonization protocol:

• Nasal mupirocin twice daily for 5-10 days
• Topical body decolonization with chlorhexidine for 5-14 days or dilute bleach baths 2, 1

Evaluation of Household Contacts

• Screen household members for MRSA colonization or active infection
• Implement hygiene measures for all household members
• Consider decolonization of household contacts if recurrent infections occur 2, 1

When to Consider Additional Follow-Up or Referral

• Additional follow-up needed for:

  • Patients with immunocompromising conditions
  • Patients with multiple recurrences
  • Infections in critical anatomic locations
  • Evidence of deeper tissue involvement 1

• Consider infectious disease consultation for:

  • Recurrent MRSA infections despite appropriate treatment and decolonization
  • Severe or invasive infections
  • Unusual antibiotic resistance patterns 1

Patient Education

• Importance of completing the full antibiotic course
• Proper wound care techniques
• Recognition of signs indicating worsening infection
• Implementation of personal and environmental hygiene measures 1

The evidence clearly demonstrates that proper follow-up care after MRSA treatment is essential, as studies have shown that recurrence rates can be significant. In one study, recurrence at 1 month of follow-up occurred in 6.8% of clindamycin-treated patients and 13.5% of TMP-SMX-treated patients 3, highlighting the importance of comprehensive post-treatment care.