Severity

Management

Mild

I&Da

Moderate

– I&D and antibiotic therapy

– Empiric treatment options:

1) Cephalexin if there is low risk for MRSA or confirmed MSSA

2) TMP/SMX

3) Doxycycline

4) Clindamycinb

– If polymicrobial coverage is required (eg, perioral/perirectal abscess, penetrating trauma): amoxicillin/clavulanate ± doxycycline/SMX-TMP (if there are concerns for MRSA)

Severe

– I&D and antibiotic therapy

– Empiric treatment options: one of vancomycin, daptomycinc, or linezolidc

and

One of the following combinations:

1) Piperacillin/tazobactamd

2) Ciprofloxacin and metronidazoled

3) Ceftriaxone and metronidazolee

– Adjust treatment options based on susceptibilities

a Oral antibiotics with activity against Staphylococcus aureus can be considered in case of extensive surrounding cellulitis, immunocompromised state, inadequate response to I&D alone (with good source control), abscess size >2 cm.

b Clindamycin may be considered if clindamycin local resistance is <10%-15% and/or there are other compelling indications. It should be avoided as a first-line option.

c Consultation with infectious diseases is recommended prior to initiation of these agents.

d Review local antibiogram data if this combination is being used for coverage of Pseudomonas aeruginosa.

e If the patient has risk factors for P aeruginosa infection, this combination would not provide adequate coverage.