From the Research
Prophylactic antibiotics for Bartholin cysts typically include broad-spectrum coverage with amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 7-10 days, or alternatives such as doxycycline 100 mg twice daily for 7 days, or clindamycin 300 mg four times daily for 7 days. These antibiotics are prescribed to prevent infection during or after drainage procedures like marsupialization or Word catheter placement. The rationale for antibiotic use is that Bartholin gland infections are often polymicrobial, involving both aerobic and anaerobic bacteria, including sexually transmitted pathogens. Common organisms include E. coli, Bacteroides, Peptostreptococcus, Neisseria gonorrhoeae, and Chlamydia trachomatis.
Key Considerations
- While not all Bartholin cysts require antibiotics, they are recommended when there are signs of infection, in immunocompromised patients, or when surgical intervention is planned 1.
- Patients should complete the full course of antibiotics even if symptoms improve quickly, and should be advised to maintain good perineal hygiene and avoid sexual intercourse until healing is complete to prevent reinfection.
- The most recent and highest quality study, a systematic review published in 2020, found that current randomised trial evidence does not support the use of any single surgical intervention for the treatment of a symptomatic cyst or abscess of the Bartholin's gland 1.
Treatment Options
- Marsupialization
- Incision, drainage and insertion of a Word catheter
- Incision, drainage and silver nitrate insertion
- Incision, drainage and cavity closure
- Antibiotic therapy, such as amoxicillin-clavulanate, doxycycline, or clindamycin, is often used in conjunction with these procedures to prevent infection 2, 3, 4, 5.
Important Notes
- The management of Bartholin's duct cysts and gland abscesses can be challenging, and the goal of treatment is to preserve the gland and its function if possible 3.
- A review of the literature failed to identify a best treatment approach, highlighting the need for further research to identify an effective treatment for Bartholin's cyst or abscess 4, 1.