What is the recommended treatment for a 41-year-old male with an indurated, red, and raised abscess in his right axilla (arm pit) with no systemic symptoms, and are clindamycin (clindamycin) wipes recommended?

Management of Axillary Abscess

For a 41-year-old male with indurated, red, raised axillary abscesses without fluctuance or drainage, incision and drainage is the primary treatment, and clindamycin wipes are not specifically recommended in guidelines for this condition. 1

Initial Assessment and Treatment

Primary Treatment

• Incision and drainage is the cornerstone of therapy for abscesses 1
• For indurated lesions without fluctuance (as in this case):
  • Warm compresses 4-6 times daily for 10-15 minutes to promote localization and drainage 1
  • Return for incision and drainage once fluctuance develops

Antibiotic Therapy

• Antibiotics are indicated in this case due to:
  • Location in the axilla (considered a difficult-to-drain area) 1
  • Multiple lesions (as described in the case) 1
  • Induration and erythema suggesting surrounding cellulitis 1

Recommended Antibiotic Regimen

1. Oral clindamycin 300-450 mg three times daily for 5-10 days 1, 2

   • Provides excellent coverage against MRSA, streptococci, and anaerobes
   • FDA-approved for serious skin and soft tissue infections 2
   • Particularly effective for axillary infections due to coverage of skin flora

2. Alternative options:

   • Trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 DS tablets twice daily 1
   • Doxycycline 100 mg twice daily 1

Regarding Clindamycin Wipes

• Clindamycin wipes are not specifically recommended in any major guidelines for treatment of axillary abscesses 1
• Topical antibiotics have limited utility for deep-seated infections like axillary abscesses
• For recurrent abscesses, a decolonization regimen may be considered, which includes:
  • Intranasal mupirocin twice daily for 5 days
  • Daily chlorhexidine washes
  • Daily decontamination of personal items 1

Follow-up Care

• Re-evaluate in 48-72 hours to:

  • Assess clinical response
  • Perform incision and drainage if fluctuance develops
  • Consider culture if no improvement (to guide antibiotic therapy) 1

• Complete the full course of antibiotics even if symptoms improve quickly

Evidence Supporting This Approach

The IDSA guidelines strongly recommend incision and drainage as primary therapy for abscesses 1. A placebo-controlled trial by Daum et al. demonstrated that adding antibiotics (clindamycin or TMP-SMX) to incision and drainage significantly improved cure rates compared to incision and drainage alone (83.1% for clindamycin vs. 68.9% for placebo) 3.

For axillary infections specifically, the IDSA guidelines recommend coverage for both MRSA and anaerobes, making clindamycin an excellent choice 1. The location in the axilla, which is considered a difficult-to-drain area, further supports the use of systemic antibiotics in addition to eventual drainage 1.

Common Pitfalls to Avoid

1. Delaying incision and drainage once fluctuance develops
2. Using only topical treatments for deep-seated abscesses
3. Failing to consider MRSA coverage for axillary abscesses
4. Discontinuing antibiotics prematurely when symptoms improve
5. Not evaluating for recurrence which may indicate need for decolonization protocol

Remember that while antibiotics are important in this case, they should not replace incision and drainage once the abscess becomes fluctuant.