What is the treatment for a male patient with a gluteal abscess using antibiotics?

From the Guidelines

For a male with a buttock abscess, treatment typically requires both surgical drainage and antibiotics, with the primary treatment being incision and drainage of the abscess by a healthcare provider, followed by antibiotic therapy, such as trimethoprim-sulfamethoxazole or clindamycin, for 7-10 days, as recommended by the Infectious Diseases Society of America 1. The choice of antibiotic should be guided by the severity of the infection, the presence of systemic signs, and the results of culture and susceptibility testing, if available.

• The most common causative organisms of skin abscesses are Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), and Streptococcus pyogenes.
• Incision and drainage of the abscess is usually adequate for simple abscesses, but antibiotic therapy may be necessary for more complex or severe infections, such as those with significant cellulitis, systemic signs, or in immunocompromised patients.
• The use of antibiotics should be individualized based on the patient's clinical response and the results of culture and susceptibility testing, if available.
• Patients should be educated on the importance of completing the full antibiotic course, even if symptoms improve quickly, and on good hygiene practices, including keeping the area clean and dry, to prevent recurrence and promote healing.
• Warm compresses applied to the area several times daily can help with healing and pain relief.
• If fever develops, the abscess worsens, or doesn't improve within 48-72 hours of treatment, immediate medical reassessment is necessary, as recommended by the Infectious Diseases Society of America 1.

From the FDA Drug Label

SKIN AND SKIN STRUCTURE INFECTIONS caused by Bacteroides species including the B. fragilis group, Clostridium species, Peptococcus niger, Peptostreptococcus species, and Fusobacterium species The FDA drug label for metronidazole 2 indicates that it is used to treat skin and skin structure infections, which may include buttock abscess.

• Treatment: Metronidazole can be used as part of the treatment for buttock abscess, particularly when caused by anaerobic bacteria.
• Note: The label also mentions that indicated surgical procedures should be performed in conjunction with metronidazole tablet therapy. However, moxifloxacin 3 is also effective against skin and skin structure infections, including abscesses.
• Treatment: Moxifloxacin can be used as an alternative treatment for buttock abscess, especially when caused by bacteria such as Staphylococcus aureus or Streptococcus pneumoniae. It is essential to note that the choice of antibiotic should be based on the suspected or confirmed causative pathogen and local resistance patterns.

From the Research

Treatment of Buttock Abscess in Males

• The treatment of buttock abscesses typically involves incision and drainage (I&D) of the abscess, as seen in studies 4, 5, 6, 7.
• The use of antibiotics in the treatment of buttock abscesses is not always necessary, and their effectiveness is still a topic of debate 4, 8, 6, 7.
• According to 4, wound culture and antibiotics do not improve healing, but packing wounds larger than 5 cm may reduce recurrence and complications.
• Study 8 suggests that surgical drainage is of primary importance in the treatment of anaerobic infections, which can cause buttock abscesses, and that antimicrobials should be used to limit the local and systemic spread of infection.
• The use of antibiotics may be considered in certain cases, such as in immunocompromised patients or in the presence of high-risk features, as seen in study 7.
• Alternative treatments, such as needle aspiration and loop drainage, may also be suitable for certain types of abscesses, as discussed in study 6.