Antibiotic regimen for abdominal wall abscess due to MRSA
Incision and drainage is recommended as the primary treatment for an abscess. [1]
Systemic antibiotics active against MRSA should be added to incision and drainage when systemic inflammatory response syndrome is present or when host factors increase risk of treatment failure. [1]
For MRSA-covered outpatient oral therapy, doxycycline, clindamycin, or trimethoprim-sulfamethoxazole are recommended. [1]
Medication selection algorithm
MRSA-directed oral options after incision and drainage are: [1]
- Doxycycline (100 mg PO twice daily). [1]
- Clindamycin (300–450 mg PO four times daily). [1]
- Trimethoprim-sulfamethoxazole (1–2 double-strength tablets PO twice daily). [1]
Monotherapy versus combination therapy
MRSA-directed monotherapy is recommended for purulent abscesses when gram-negative and anaerobic coverage is not required. [1]
Additional streptococcal coverage is not required when the infectious syndrome is a purulent abscess due to MRSA. [1]
Treatment initiation thresholds and indications
Adjunct MRSA-active antibiotics should be administered with incision and drainage when any of the following systemic inflammatory response syndrome criteria are present: [1]
- Temperature >38°C or <36°C. [1]
- Tachypnea >24 breaths per minute. [1]
- Tachycardia >90 beats per minute. [1]
- White blood cell count >12,000 cells/µL or <400 cells/µL. [1]
MRSA-active antibiotics should also be administered when the abscess is in a setting associated with impaired drainage or when host factors increase risk of failure of incision and drainage alone. [1]
Route and escalation options
Oral MRSA-directed therapy can be used for appropriate outpatients after incision and drainage. [1]
If initial empiric management requires broader MRSA-active coverage for severe infection in surgical site infection contexts, parenteral MRSA agents such as vancomycin can be used. [1]
Duration of therapy
A 5-day course is recommended for bacterial skin and soft tissue infections treated with antibiotics. [1]
Treatment duration should be extended if clinical improvement has not occurred by 5 days. [1]
Common pitfalls to avoid
Failure to perform incision and drainage is a common cause of persistent infection. [1]
Failure to add MRSA-active therapy when systemic inflammatory response syndrome is present increases the risk of treatment failure compared with incision and drainage alone in appropriately selected patients. [1]
Targets of therapy
Clinical improvement should be demonstrated within 5 days of initiating antibiotics. [1]