From the Guidelines
For an infected sebaceous cyst on the back, empiric antibiotic coverage should target Staphylococcus aureus and Streptococcus species, which are the most common causative organisms, with clindamycin 300-450 mg four times daily for 7-10 days being a recommended option, as it provides coverage for both b-hemolytic streptococci and CA-MRSA, according to the 2014 guidelines by the Infectious Diseases Society of America 1.
Key Considerations
- The decision to administer antibiotics should be based on the presence or absence of systemic inflammatory response syndrome (SIRS) and the severity of the infection.
- Incision and drainage is often necessary alongside antibiotics for adequate treatment, especially for fluctuant or large lesions.
- Warm compresses applied to the area several times daily can help promote drainage and healing.
Antibiotic Options
- Clindamycin 300-450 mg four times daily for 7-10 days is a recommended option for empiric coverage of CA-MRSA and b-hemolytic streptococci.
- Other options include trimethoprim-sulfamethoxazole (TMP-SMX) DS twice daily, doxycycline 100 mg twice daily, or linezolid 600 mg twice daily for 7-10 days.
Important Notes
- The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended, as stated in the 2011 guidelines by the Infectious Diseases Society of America 1.
- The choice of antibiotic should be based on the patient's clinical response and the presence of any underlying conditions, such as allergies or immunosuppression.
- If the infection doesn't improve within 48-72 hours of starting antibiotics, reassessment is necessary to consider culture-guided therapy or possible surgical intervention.
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 staphylococci Serious skin and soft tissue infections; septicemia; Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin
The antibiotic coverage needed for an infected sebaceous cyst on the back may include clindamycin as it covers serious skin and soft tissue infections, including those caused by staphylococci, which are commonly found in skin infections 2.
- Staphylococci and streptococci are common causes of skin and soft tissue infections.
- Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to the chosen antibiotic. It is essential to note that the choice of antibiotic should be based on the results of bacteriologic studies and the susceptibility of the causative organisms to the antibiotic 2.
From the Research
Antibiotic Coverage for Infected Sebaceous Cyst
- The infected sebaceous cyst on the back is likely caused by Staphylococcus aureus, which is the most common pathogen isolated in skin-and-soft-tissue infections (SSTIs) in the United States 3.
- The treatment for S. aureus SSTIs usually involves oral therapy, with parenteral therapy reserved for severe presentations, and ranges from cephalosporins and penicillin agents such as oxacillin for methicillin-sensitive S. aureus (MSSA) to vancomycin for methicillin-resistant S. aureus (MRSA) 3.
- Empiric therapy should be given to cover methicillin-resistant S. aureus, and bacterial wound cultures are important for characterizing local susceptibility patterns 4.
- The choice of antibiotic is predicated by the infection severity, local susceptibility patterns, and drug-related safety, tolerability, and cost, and 5 to 7 days of therapy is typically adequate to achieve cure 4.
- There is no specific study on the antibiotic coverage needed for an infected sebaceous cyst on the back, but the management plan of any infected sebaceous cyst typically involves incision and drainage, and the infected tissue is excised along with a rim of healthy tissue and then closed by Prolene in the same sitting 5.