Treatment of Buttock Abscess with MRSA Sensitive to Trimethoprim/Sulfamethoxazole
For a buttock abscess with culture positive for Staphylococcus and MRSA sensitive to trimethoprim/sulfamethoxazole, incision and drainage plus oral trimethoprim/sulfamethoxazole is the recommended treatment. 1
Primary Management
Incision and Drainage
- Surgical drainage is the primary intervention for any abscess
- Complete evacuation of purulent material is essential 1
- Ensure adequate drainage with appropriate wound packing if needed
Antimicrobial Therapy
Evidence Supporting This Approach
- The IDSA guidelines strongly recommend TMP-SMX for MRSA skin infections when the organism is susceptible 1
- A randomized controlled trial demonstrated that TMP-SMX treatment resulted in higher cure rates for drained cutaneous abscesses compared to placebo in settings where MRSA was prevalent 2
- For buttock abscesses specifically, the location near the perineum may warrant special consideration for antimicrobial coverage 1
Duration of Treatment
- A 7-10 day course of TMP-SMX is recommended for uncomplicated skin abscesses 1, 2
- Evidence suggests that shorter courses (3 days) are associated with higher failure and recurrence rates compared to longer courses (10 days) for MRSA abscesses 3
Dosing Considerations
- Standard dosing (160mg/800mg twice daily) is typically sufficient for uncomplicated abscesses 4
- Higher dosing (320mg/1600mg twice daily) has not shown significant improvement in clinical resolution rates for MRSA skin infections 4
Monitoring and Follow-up
- Evaluate the patient 7-14 days after treatment initiation to assess clinical outcome 2
- Monitor for potential adverse effects of TMP-SMX:
Common Pitfalls to Avoid
- Inadequate drainage: Relying solely on antibiotics without proper incision and drainage will likely lead to treatment failure
- Insufficient treatment duration: Using too short a course (less than 7 days) for MRSA infections increases risk of recurrence 3
- Neglecting wound care: Proper wound care instructions should be provided to prevent reinfection
- Missing follow-up: Patients should be instructed to return if symptoms worsen or fail to improve within 48-72 hours
By following this treatment approach with proper surgical drainage and appropriate antibiotic therapy based on culture sensitivity, most patients with buttock abscesses due to MRSA should experience clinical resolution.