From the Guidelines
Scrotal abscesses are typically treated with incision and drainage, and oral antibiotics may be used in certain cases, such as severe or extensive disease, or when there are signs of systemic illness.
Oral Antibiotic Options
- Clindamycin is a recommended option for empirical coverage of CA-MRSA in outpatients with SSTI, including scrotal abscesses, with a dose of 300-450 mg PO TID 1.
- Trimethoprim-sulfamethoxazole (TMP-SMX) is another option, with a dose of 1-2 DS tab PO BID for adults and trimethoprim 4-6 mg/kg/dose, sulfamethoxazole 20-30 mg/kg/dose PO every 12 h for pediatric patients 1.
- Doxycycline or minocycline may also be used, with a dose of 100 mg PO BID for doxycycline and 200 mg 3 1, then 100 mg PO BID for minocycline 1.
- Linezolid is an option, but it is more expensive compared to other alternatives, with a dose of 600 mg PO BID for adults and 10 mg/kg/dose PO every 8 h, not to exceed 600 mg/dose for pediatric patients 1.
Key Considerations
- Antibiotic therapy is recommended for abscesses associated with severe or extensive disease, signs of systemic illness, or lack of response to incision and drainage alone 1.
- The choice of antibiotic should be based on the severity of the infection, the presence of comorbidities, and the potential for resistance 1.
- 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 Research
Oral Antibiotics for Scrotal Abscess
The use of oral antibiotics for scrotal abscess is mentioned in a few studies, although the specific antibiotics used are not always specified.
- In the study 2, a patient with a spermatic cord abscess was initially treated with oral antibiotics for an episode of bacterial epididymo-orchitis two months prior to the abscess diagnosis.
- The study 3 mentions that a patient with an intratesticular abscess was discharged home with oral antibiotics after surgical exploration and evacuation of the abscess.
- The study 4 notes that five cases of epididymal and/or testicular abscess were treated with antibiotics alone, although it does not specify whether these were oral or intravenous antibiotics.
- The study 5 mentions that a patient with a scrotal abscess was treated with antibiotics, but it does not specify whether these were oral or intravenous.
Limitations of Current Evidence
There is limited information available on the specific oral antibiotics used to treat scrotal abscess.
- Most studies focus on the surgical management of scrotal abscesses, with antibiotics playing a secondary role.
- Further research is needed to determine the most effective oral antibiotics for treating scrotal abscesses.