From the Guidelines
For skin abscesses, incision and drainage (I&D) is the primary treatment, and antibiotics are often not necessary for simple, uncomplicated abscesses. However, antibiotics are recommended for abscesses with certain features: severe or extensive disease, rapid progression, systemic illness signs, immunosuppression, extremes of age, abscess in difficult-to-drain area, or associated septic phlebitis. When antibiotics are needed, empiric coverage for methicillin-resistant Staphylococcus aureus (MRSA) is typically recommended.
Key Considerations
- First-line options include trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily, doxycycline 100mg twice daily, or clindamycin 300-450mg three times daily, all for 5-10 days 1.
- For more severe infections, consider linezolid 600mg twice daily or intravenous options like vancomycin 1.
- Patients should complete the full antibiotic course, keep the wound clean, and seek medical attention if symptoms worsen or don't improve within 48 hours.
Antibiotic Options
- Clindamycin: 300-450mg three times daily for 5-10 days 1.
- TMP-SMX: 1-2 double-strength tablets twice daily for 5-10 days 1.
- Doxycycline: 100mg twice daily for 5-10 days 1.
- Linezolid: 600mg twice daily for 5-10 days 1. These recommendations target the most common causative organisms (Staphylococcus aureus and Streptococcus species) while accounting for the high prevalence of MRSA in community-acquired skin infections 1.
From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylocci... Serious skin and soft tissue infections
- Skin abscess can be considered a type of serious skin and soft tissue infection.
- Clindamycin is indicated for the treatment of serious skin and soft tissue infections caused by susceptible strains of bacteria, including staphylococci, which are commonly associated with skin abscesses.
- The use of clindamycin should be guided by bacteriologic studies to determine the causative organisms and their susceptibility to clindamycin 2.
From the Research
Skin Abscess Antibiotic Treatment
- The treatment of uncomplicated skin and soft-tissue abscesses caused by meticillin-sensitive Staphylococcus aureus or meticillin-resistant S. aureus (MRSA) is problematic, with limited oral antibiotic therapy options 3.
- Common oral antibiotics used for community-acquired MRSA (CA-MRSA) include clindamycin, doxycycline, and trimethoprim-sulfamethoxazole (TMP-SMX), but these often fail to eradicate the infection 3.
- Minocycline is reliably effective in treating uncomplicated cutaneous abscesses due to CA-MRSA when doxycycline or TMP-SMX fails 3.
- A randomized trial found that trimethoprim-sulfamethoxazole was superior to placebo in treating uncomplicated abscesses, with a higher clinical cure rate and lower rates of subsequent surgical drainage procedures and skin infections at new sites 4.
- The use of post-procedural antibiotics is not always necessary, and studies have shown that incision and drainage (I&D) alone can be sufficient for the treatment of uncomplicated abscesses 5.
- However, antibiotics should be considered in the presence of high-risk features, such as immunocompromised patients or positive wound cultures for MRSA 5.
- Current guidelines for the treatment of uncomplicated skin and skin structure infections (uSSSIs) include oral beta-lactams, such as dicloxacillin, cephalexin, and amoxicillin/clavulanic acid, as well as clindamycin, doxycycline, and trimethoprim-sulfamethoxazole (SXT) 6.
- The choice of antibiotic should be guided by local susceptibility patterns and the probability of the infection being caused by MRSA 6.
- A postoperative systemic antibiotic treatment is only indicated under certain conditions, such as high-risk features or positive wound cultures for MRSA 7.