Best Antibiotic for Infected Pilonidal Cyst
For infected pilonidal cysts requiring antibiotic therapy, clindamycin 300-450 mg orally three times daily plus trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily) is the first-line regimen. 1, 2
When to Use Antibiotics
Antibiotics should be added to incision and drainage (the primary treatment) when systemic inflammatory response syndrome (SIRS) is present, including:
Incision and drainage remains the cornerstone of treatment; antibiotics alone are insufficient. 2
First-Line Antibiotic Regimen
Clindamycin 300-450 mg orally three times daily PLUS trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily) 1, 2
This combination targets the most common pathogens in perineal skin and soft tissue infections, which are the typical organisms causing pilonidal cyst infections. 2
Alternative Regimens
For Penicillin Allergy
Clindamycin plus ciprofloxacin is the recommended alternative. 1, 2
For Perineal Involvement
Important Caveats
Avoid beta-lactams as first-line agents - they demonstrate inferior efficacy and more adverse effects compared to other antimicrobials for skin infections. 1, 2
Reserve fluoroquinolones for cases where other antibiotics cannot be used due to their propensity for collateral damage and resistance development. 1, 2
Duration of Therapy
- Uncomplicated cases: 5-7 days following adequate drainage 2
- Severe or complicated infections: 10-14 days based on clinical response 2
Recurrent Infections
For patients with recurrent pilonidal abscesses:
- Treat with antibiotics active against the isolated pathogen 1
- Consider a 5-day decolonization regimen with intranasal mupirocin and chlorhexidine washes 1, 2
Critical Pitfall
Failure to properly drain the abscess is the most common reason for treatment failure, not antibiotic selection. 2 Antibiotics must be used as an adjunct to surgical drainage, never as monotherapy for an undrained abscess.