From the Guidelines
Taking cephalexin (Keflex) and doxycycline together for abscess coverage is not the recommended first-line approach, as the primary treatment for uncomplicated skin abscesses is incision and drainage, with antibiotics being secondary. According to the clinical practice guidelines by the Infectious Diseases Society of America 1, for outpatients with purulent cellulitis or abscesses, empirical therapy for CA-MRSA is recommended pending culture results, and options include clindamycin, trimethoprim-sulfamethoxazole, a tetracycline (such as doxycycline), or linezolid.
- The use of cephalexin alone may be sufficient for some cases, as it works well against many gram-positive bacteria, including Staphylococcus aureus.
- Doxycycline alone may also be sufficient, as it covers both gram-positive and some gram-negative organisms.
- Combining cephalexin and doxycycline does not significantly broaden coverage and increases the risk of side effects, such as gastrointestinal distress, allergic reactions, and disruption of normal gut flora.
- For severe or complex abscesses, different antibiotic combinations might be appropriate, but these should be prescribed by a healthcare provider after proper evaluation of the infection and consideration of local resistance patterns, as recommended by the guidelines 1. Some key points to consider when deciding on antibiotic therapy for abscesses include:
- The severity and extent of the disease
- The presence of associated cellulitis or systemic illness
- The patient's comorbidities or immunosuppression
- The location of the abscess (e.g., face, hand, or genitalia)
- The lack of response to incision and drainage alone, as outlined in the guidelines 1.