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