From the Guidelines
For recurrent groin abscesses in a 50-year-old female, the recommended antibiotic treatment is typically a combination of incision and drainage (I&D) plus oral antibiotics targeting Staphylococcus aureus, including MRSA, with first-line therapy being trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets (800mg/160mg) twice daily for 5-10 days, as recommended by the Infectious Diseases Society of America 1. The choice of antibiotic should be guided by the severity of the infection, the presence of systemic symptoms, and the results of bacterial cultures obtained during I&D.
- Alternatives to TMP-SMX include clindamycin 300-450mg orally four times daily, doxycycline 100mg twice daily, or minocycline 100mg twice daily for the same duration.
- For severe cases or those with systemic symptoms, consider vancomycin 15-20mg/kg IV every 8-12 hours, as recommended for hospitalized patients with complicated skin and soft tissue infections (cSSTI) 1. The recurrent nature of the abscesses suggests possible hidradenitis suppurativa, which may require longer-term management with antibiotics like doxycycline 100mg twice daily for 3 months, or a combination of clindamycin 300mg twice daily with rifampin 300mg twice daily for 10-12 weeks, although the use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended 1. Addressing contributing factors like hygiene, obesity, diabetes control, and immunosuppression is essential, and recurrent cases may benefit from decolonization protocols using chlorhexidine washes and intranasal mupirocin if S. aureus colonization is confirmed.
- 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.
From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylocci Serious skin and soft tissue infections Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin
The best antibiotic treatment for a 50-year-old female with recurrent furuncles (abscesses) in the inguinal (groin) area is not explicitly stated in the provided drug label. However, clindamycin may be considered for the treatment of serious skin and soft tissue infections.
- The key factors to consider are:
- The causative organisms of the infection and their susceptibility to clindamycin
- The presence of any penicillin allergy or other conditions that may make clindamycin a more suitable option
- The potential risks and benefits of clindamycin, including the risk of colitis 2
From the Research
Treatment Options for Recurrent Furuncles in the Inguinal Area
- The treatment of recurrent furuncles (abscesses) in the inguinal area typically involves a combination of surgical drainage and antibiotic therapy 3.
- Computed tomography (CT) is a useful diagnostic tool for determining the extent of the infection and guiding antibiotic treatment and surgical planning 3.
- Gram-positive pathogens are commonly associated with infections involving the hip or thigh muscles, while gram-negative pathogens are associated with infections involving the gastrointestinal and genitourinary tracts 3.
Antibiotic Treatment
- Minocycline is often preferred over trimethoprim-sulfamethoxazole or doxycycline for the treatment of community-acquired meticillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections, including furuncles 4.
- Clindamycin, doxycycline, and trimethoprim-sulfamethoxazole are also commonly used oral antibiotics for the treatment of uncomplicated community-acquired MRSA skin and soft-tissue infections 4.
- Broad-spectrum antibiotics and local measures may be effective in treating periclitoral abscesses and preventing surgical treatment and potential associated morbidity 5.
Recurrent Abscesses
- Recurrent abscesses can be challenging to treat and may require repeated percutaneous drainage or surgical intervention 6, 7.
- Secondary percutaneous abscess drainage can be effective in evacuating the abscess cavity and avoiding surgery in some patients 7.
- The underlying cause of the abscess, such as an intra-abdominal or gastrointestinal source, should be investigated and addressed to prevent recurrence 3, 6.