What is the recommended duration of antibiotic therapy for a skin and soft tissue abscess?

Duration of Antibiotic Therapy for Skin and Soft Tissue Abscess

For uncomplicated skin and soft tissue abscesses that have been adequately drained, antibiotics are often not required at all, but when prescribed, the duration should be 5-7 days maximum. 1

Primary Management: Incision and Drainage

• Incision and drainage is the definitive treatment for abscess, and adjunctive systemic antimicrobial therapy is not routinely indicated for simple abscesses after adequate drainage 1
• Antibiotics should be added to incision and drainage when there are signs of systemic infection (fever, tachycardia, hypotension), significant surrounding cellulitis (erythema and induration extending >5 cm from the wound edge), or in immunocompromised patients 1

Antibiotic Duration When Indicated

Standard Duration

• When antibiotics are prescribed for uncomplicated abscesses after drainage, 5-7 days is the recommended duration 1, 2
• The IDSA guidelines specifically recommend 5 days as the standard duration, with extension only if the infection has not improved within this time period 1

Recurrent Abscesses

• For recurrent abscesses at a site of previous infection, treat with a 5- to 10-day course of an antibiotic active against the cultured pathogen after obtaining cultures 1
• Consider a 5-day decolonization regimen (twice daily intranasal mupirocin, daily chlorhexidine washes, and daily decontamination of personal items) for recurrent S. aureus infections 1

Antibiotic Selection

• Empiric coverage should target MRSA in most community-acquired purulent SSTIs, as methicillin-resistant S. aureus is the most common pathogen 2
• Appropriate oral options include: trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily), doxycycline (100 mg twice daily), or clindamycin (300-450 mg four times daily) 1
• For severe infections requiring IV therapy: vancomycin (30 mg/kg/day in 2 divided doses), linezolid (600 mg every 12 hours), or daptomycin (4 mg/kg every 24 hours) 1

Common Pitfalls to Avoid

• Excessive duration is the most common error: Studies show that 80% of patients receive inappropriately long courses (>10 days), with 28% receiving >14 days 3
• Prescribing antibiotics when drainage alone is sufficient: For well-drained abscesses without systemic signs or extensive cellulitis, antibiotics add no benefit 1
• Failure to obtain cultures in recurrent cases: Blood cultures and wound cultures should be obtained in recurrent abscesses to guide targeted therapy 1
• Using broad-spectrum gram-negative or anaerobic coverage unnecessarily: 45% of patients receive inappropriate extended-spectrum gram-negative coverage and 40% receive unnecessary anaerobic coverage for simple SSTIs 3

Special Populations

Neutropenic Patients

• For bacterial SSTIs in neutropenic patients, the recommended duration is 7-14 days with broader empiric coverage including vancomycin plus antipseudomonal agents 1

Diabetic Foot Infections

• These complicated infections require 14-28 days of treatment, which is substantially longer than simple abscesses 4