ABSCESS, CARBUNCLES, AND FURUNCLES

CAUSATIVE ORGANISMS
  • Primarily Staph aureus
  • Abscesses can be polymicrobial including skin flora but mostly staph aureus​

CLASSIFICATIONS OF SEVERITY
  • MILD: No systemic signs of infection
  • MODERATE: With systemic signs of infection (fever)
  • SEVERE: Patients who failed I&D and oral antibiotics or immunocompromised patients or advanced age or multiple abscesses or those with signs of SIRS (systemic inflammatory response syndrome ) such as:
    1. Temp >38°C or <36°C​
    2. Tachypnea (>24 breaths per minute)
    3. Tachycardia (>90 bpm)
    4. WBC >12000 or <400 cells/uL

RECOMMENDED TREATMENT
  • Gram stain and culture of pus recommended
  • Incision and drainage is recommended for all severities
  • ANTIBIOTICS BY SEVERITY OF INFECTION
    • MILD
      • ​None required if adequately drained
    • MODERATE
      • Sulfamethoxazole/Trimethoprim 800/160 mg 1-2 tabs PO BID PLUS cephalexin 500 mg PO QID
      • Doxycycline 100 mg PO BID PLUS cephalexin 500 mg PO QID
      • If penicillin/cephalosporin allergy, substitute clindamycin 300 mg PO QID for cephalexin
    • SEVERE
      • Hospitalization required - obtain blood cultures x2 sets
      • Vancomycin (preferred)
      • For Vancomycin allergies: Daptomycin (requires consult with ID) or Linezolid (requires consult with ID)

inflamed epidermoid cyst

CAUSATIVE ORGANISMS
  • Generally not an infectious process, mostly skin flora​​

RECOMMENDED TREATMENT
  • Gram stain and culture is NOT recommended
  • Incision and drainage is treatment of choice
  • No antibiotics are recommended or indicated as it is not an infectious process​​​

recurrent abscesses

RECOMMENDED TREATMENT
  1. Gram stain and culture of pus is recommended
  2. Incision and drainage
  3. Search for local causes​
    • ​Pilonidal cyst
    • ​Foreign material​
    • Hidradenitis suppurativa- doxycycline 100 mg PO BID for months to reduce flare-ups but not curative.
  4. ​After obtaining cultures, treat with a 5 to 10 day course of antibiotic active against pathogen isolated
  5. Consider a 5 day decolonization regimen if staph aureus is isolated
    1. Mupirocin intranasal BID x 5 days
    2. Daily chlorhexidine washes
    3. Daily decontamination of personal items (towels, sheets, clothes)
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