MRSA Abscess – To Give Abx or Not To Give Abx?

1. Our Surgical colleagues often would like us to believe that a scalpel can fix any problem – in this case, they may be correct.

2. We often prescribe antibiotics after drainage of a simple abscess… perhaps to make us feel better… perhaps because we are worried that MRSA will make simple I+D less effective.

3. Recently the Infectious Diseases Society of America published their Clinical Practice Guidelines pertaining to MRSA treatment in adults and children. (www.idsociety.org)

4. Important points:
⇒ Incision and Drainage is as effective as treating as I+D plus antibiotics for simple abscesses
(1) If it is 5cm or less, not rapidly expanding, and the child is well-appearing: I+D alone
(1) Save the kid the additionally exposure to the unnecessary antibiotics

⇒ Use Antibiotics in addition to I+D for:
(1) Severe or extensive disease (involving multiple sites, rapidly progressing, or significant cellulitis)
(2) Signs and symptoms of systemic illness
(3) Associated with co-morbidities or immunosuppression
(4) Abscess in area that is difficult to drain adequately (hand, face, genitalia)
(1) Lack of response to prior I+D alone

⇒ If you are going to start antibiotics, send a wound culture! Let’s make sure we know what we are treating. This is unnecessary if you are going to only perform I+D.

5. So, in the end, do a good job of getting the pus out, give good wound care instructions, and save the antibiotics for those who really need it.

Liu, Catherin et al. Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children. Clin Infect Dis. (2011) doi: 10.1093/cid/ciq146

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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1 Response

  1. March 17, 2017

    […] that often requires a procedure is the subcutaneous abscess. We have previously discussed whether antibiotics are needed for abscesses. Now let us look at whether there is another strategy to the classic incision and drainage: […]

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