Treatment of skin abscess in adults

ESBL: extended-spectrum beta-lactamase; IV: intravenous; MRSA: methicillin-resistant Staphylococcus aureus.

* For patients with septic shock or an immunocompromising condition who cannot take any beta-lactam agents, we suggest IV vancomycin plus either levofloxacin (750 mg IV once daily) or aztreonam (2 g IV every 6 to 8 hours). The majority of patients with reported beta-lactam allergies can take a cephalosporin (refer to UpToDate content for details).

¶ Once culture and susceptibility data are available, narrow antibiotics to target the pathogen as appropriate.

Δ For further details about vancomycin dosing, refer to UpToDate content for details.

◊ Close observation without incision and drainage is acceptable for stable patients with small abscesses (<2 cm) that are spontaneously draining.

§ Some experts would forego antibiotic therapy in select patients (eg, healthy patients with a single abscess <2 cm in diameter, minimal surrounding cellulitis, and no significant comorbidities).

¥ Five days of antibiotic therapy is generally adequate; extension up to 14 days may be warranted for slow clinical response.

‡ For patients who weigh more than 70 kg and have normal renal function, we favor two double-strength tablets twice daily.

† For patients with risk factors for endocarditis, we add amoxicillin (875 mg orally twice daily) to doxycycline or minocycline for beta-hemolytic streptococcal coverage.

** We generally avoid clindamycin due to risk for C. difficile infection and staphylococcal resistance rates. Local resistance rates should be reviewed before prescribing.