What is the best antibiotic treatment for a 50-year-old female with recurrent furuncles (abscesses) in the ingercrural (groin) area?

From the Guidelines

For recurrent groin abscesses in a 50-year-old female, the recommended antibiotic treatment is typically trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets (160mg/800mg) twice daily for 7-10 days, as it provides good coverage against methicillin-resistant Staphylococcus aureus (MRSA) 1. This recommendation is based on the guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children, which suggest that empirical therapy for CA-MRSA is recommended pending culture results for outpatients with purulent cellulitis 1. Some key points to consider in the treatment of recurrent groin abscesses include:

• Incision and drainage (I&D) of the abscess is crucial and should be performed before starting antibiotics 1.
• The patient should also be evaluated for hidradenitis suppurativa, a chronic inflammatory skin condition that causes recurrent abscesses in the groin and axillary regions.
• Daily chlorhexidine washes and intranasal mupirocin ointment twice daily for 5 days may help prevent recurrences if the patient is colonized with S. aureus.
• Cultures should be obtained during I&D to guide antibiotic therapy based on susceptibility results 1. Alternative antibiotic options include clindamycin 300-450mg orally four times daily for 7-10 days, especially if the patient has a sulfa allergy, and doxycycline 100mg twice daily for 7-10 days 1. However, it is essential to note that antibiotics alone are insufficient for treatment, and I&D is the primary treatment for cutaneous abscesses 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 staphylococci Serious skin and soft tissue infections; septicemia; 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 clindamycin 2, as it is indicated for the treatment of serious skin and soft tissue infections, which includes furuncles. However, bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin.

• Key considerations:
  • The patient's infection should be proven or strongly suspected to be caused by susceptible bacteria.
  • Local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy in the absence of culture and susceptibility information.
  • The use of clindamycin should be reserved for patients for whom a penicillin is inappropriate, due to the risk of colitis.

From the Research

Antibiotic Treatment for Recurrent Furuncles in the Inguinal Area

• The treatment of uncomplicated skin and soft-tissue abscesses caused by meticillin-sensitive Staphylococcus aureus or meticillin-resistant S. aureus (MRSA) is problematic 3.
• Oral antibiotic therapy for uncomplicated community-acquired MRSA (CA-MRSA) is limited, and frequent choices include clindamycin, doxycycline, or trimethoprim-sulfamethoxazole (TMP-SMX) 3.
• Minocycline is reliably effective in situations where doxycycline or TMP-SMX fails in the treatment of uncomplicated cutaneous abscesses due to CA-MRSA 3.
• The most common bacteria causing cellulitis are Staphylococcus aureus, Streptococcus pyogenes, and other β-hemolytic streptococci, and methicillin-resistant S. aureus is most common in abscesses 4.
• Treatment for cellulitis typically involves a penicillin or cephalosporin, and treatment of abscesses is incision and drainage, with loop drainage preferred over the traditional incision and drainage technique, and adjunctive antibiotics can be considered 4.

Specific Considerations for Inguinal Abscesses

• Inguinal abscesses can present as tender inguinal masses that can extend from gastrointestinal, genitourinary, or retroperitoneal sites as well as being of miscellaneous origin 5.
• Computed tomography (CT) can provide a sensitive means for establishing the correct diagnosis and surgical plan of treatment for inguinal abscesses 5.
• Gram-positive pathogens are associated with infections involving hip or thigh muscles, and gram-negative pathogens are associated with infections involving the gastrointestinal (GI) and genitourinary (GU) tracts as well as with abscesses of the psoas muscle 5.
• Early recognition of the origin of the inguinal abscess can facilitate further surgical planning and possibly improve the outcome 5.

Management of Recurrent Cutaneous Abscesses

• Recurrent cutaneous abscesses can be a complication of therapy with anti-tumor necrosis factor-α (TNF-α) agents, such as infliximab 6.
• Prophylactic antibiotic therapy with amoxicillin + clavulanic acid can be effective in preventing recurrent cutaneous abscesses in patients receiving infliximab 6.
• Staphylococcus lugdunensis can be a cause of abscesses in the perineal area, and identifying coagulase-negative staphylococci to species level can be important in some instances 7.