What are the guidelines for antibiotic therapy before and after surgical treatment of an infected sebaceous cyst, including first-line and alternative antibiotics, and their recommended course durations?

From the Guidelines

The medical treatment for an infected sebaceous cyst typically involves a combination of antibiotic therapy and surgical intervention, with empiric antibiotic therapy initiated before surgical treatment and continued for 5-7 days after surgical drainage or excision. Before surgical treatment, first-line options include amoxicillin-clavulanate (625 mg three times daily or 1g twice daily) or cephalexin (500 mg four times daily) for 5-7 days to control the infection, as recommended by 1. Alternative antibiotics include clindamycin (300-450 mg four times daily) for penicillin-allergic patients or co-trimoxazole (960 mg twice daily) for suspected MRSA infections.

The choice of antibiotic should be based on the severity of infection, patient allergies, and local resistance patterns. In India, available antibiotics for treating infected sebaceous cysts include:

• amoxicillin-clavulanate (Augmentin)
• cephalexin (Keflex)
• clindamycin (Dalacin C)
• co-trimoxazole (Septran)
• doxycycline (Doxytet)
• azithromycin (Azithral)
• ciprofloxacin (Ciprobid)
• linezolid (Linezolid) for severe cases

Surgical intervention remains essential for definitive treatment, as antibiotics alone cannot adequately treat the cyst. The procedure typically involves incision and drainage for acutely infected cysts or complete excision for recurrent or large cysts once the acute infection has resolved. Proper wound care after the procedure is crucial to prevent reinfection and promote healing. According to 1, the duration of antibiotic prescription should be brief, typically limited to the operative period, sometimes 24 hours, exceptionally 48 hours, and never beyond.

It is essential to note that the most recent and highest quality study, 1, published in 2019, provides the most up-to-date guidance on antibiotic prophylaxis in surgery, emphasizing the importance of limiting antibiotic prescription to the operative period. In contrast, older studies, such as 1 and 1, published in 2011 and 2014, respectively, provide valuable information on the diagnosis and management of skin and soft tissue infections but may not reflect the current best practices in antibiotic prophylaxis. Therefore, the recommendations based on 1 should be prioritized in clinical practice.

From the FDA Drug Label

Cefuroxime for Injection, USP has been used successfully in these mixed infections in which several organisms have been isolated In certain cases of confirmed or suspected gram-positive or gram-negative sepsis or in patients with other serious infections in which the causative organism has not been identified, Cefuroxime for Injection, USP may be used concomitantly with an aminoglycoside The preoperative prophylactic administration of Cefuroxime for Injection, USP may prevent the growth of susceptible disease-causing bacteria and thereby may reduce the incidence of certain postoperative infections in patients undergoing surgical procedures Cefuroxime for Injection, USP should usually be given one-half to 1 hour before the operation to allow sufficient time to achieve effective antibiotic concentrations in the wound tissues during the procedure. Prophylactic administration is usually not required after the surgical procedure ends and should be stopped within 24 hours.

The medical treatment guideline for an infected sebaceous cyst on the skin involves antibiotic therapy before and after the surgical procedure.

• First-line antibiotics that can be used include Cefuroxime 2.
• The course duration of Cefuroxime is usually not required after the surgical procedure ends and should be stopped within 24 hours.
• In cases where the surgical procedure is lengthy, the dose should be repeated intraoperatively.
• If an infection is present, antimicrobial therapy should be instituted based on the identification of the causative organism.
• Alternative antibiotics that can be used include aminoglycosides, which may be used concomitantly with Cefuroxime in certain cases.
• Available antibiotics in the market in India to treat infected sebaceous cyst include Cefuroxime 2.

From the Research

Medical Treatment Guideline for Infected Sebaceous Cyst

The medical treatment guideline for infected sebaceous cyst involves antibiotic therapy before and after surgical procedure.

Antibiotic Therapy

• First-line antibiotics: Trimethoprim and sulfamethoxazole (TMP-SMX) or clindamycin are recommended as first-line antibiotics for treating infected sebaceous cysts 3.
• Alternative antibiotics: Cephalosporins can be used as alternative antibiotics, but they are probably not effective in reducing the risk of treatment failure compared to placebo 3.
• Course duration: The course duration of antibiotics may vary depending on the severity of the infection and the patient's response to treatment. However, there is no specific information available on the course duration of different antibiotics for infected sebaceous cysts.

Surgical Procedure

• Incision and drainage: The traditional management plan for infected sebaceous cysts involves incision and drainage 4.
• Excision and closure: A new approach involves excising the infected tissue along with a rim of healthy tissue and closing the wound with Prolene sutures in the same sitting 4.
• Stitches removal: Stitches are usually removed on the 21st day in the back and 14th day in the limb 4.

Antibiotics Available in India

• Trimethoprim and sulfamethoxazole (TMP-SMX)
• Clindamycin
• Cephalosporins (e.g., cefalexin, cefaclor)
• Other antibiotics that may be available in India for treating infected sebaceous cysts include amoxicillin, azithromycin, and ciprofloxacin, although their effectiveness and recommended use may vary 3.

Note: The availability and recommended use of antibiotics may vary depending on the region and local guidelines. It is essential to consult a healthcare professional for specific guidance on treating infected sebaceous cysts.