Treatment of Skin Abscess Requiring Intravenous Antibiotics Active Against MRSA

Skin abscess management escalates when patients have systemic signs of infection, have not responded to initial treatment, or have significantly impaired host defences. In these situations, an intravenous approach is indicated.

This protocol applies to patients presenting with skin abscess who show systemic features — including fever, tachycardia, tachypnoea, or abnormal white blood cell count — as well as those who have failed incision and drainage plus oral antibiotics, and immunocompromised patients.

Treatment approach

The approach combines incision and drainage with an intravenous antibiotic selected for activity against MRSA. Several agent options are outlined in the full protocol — specific agents, dosing, and selection criteria are detailed there.

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References

DOI: 10.1093/cid/ciu296

An antibiotic active against MRSA is recommended for patients with carbuncles or abscesses who have failed initial antibiotic treatment or have markedly impaired host defenses or in patients with SIRS and hypotension (severe; Figure 1 and Table 2) (strong, low).
Severe infection: patients who have failed incision and drainage plus oral antibiotics or those with systemic signs of infection such as temperature >38°C, tachycardia (heart rate >90 beats per minute), tachypnea (respiratory rate >24 breaths per minute) or abnormal white blood cell count (<12 000 or <400 cells/µL), or immunocompromised patients.

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