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Peds ID Abx QOTW #13 Answer

a) Abscesses should be drained and cultured prior to starting antibiotics

c) Treat with bactrim for 5-7 days

d) Treat with clindamycin for 5-7 days

e) Consider referral for decolonization regimen with chlorhexidine washes and intranasal mupirocin

Which antibiotic to choose?
  • Want to cover Group A Strep and Staph aureus
  • Keflex if not concerned for MRSA (low prevalence area or you have a culture), or simple cellulitis
  • Clindamycin or Bactrim alone if concern for MRSA
    • N Engl J Med 2015; 372:1093-1103
  • A word on abscesses
    • Always I&D if significant collection of pus
    • Updated data suggest antibiotics + I&D = less recurrence than I&D alone, duration of antibiotics unclear, probably 5-7 days
      • NEJM 2016;374:823-32 and┬áNEJM 2017;376(26):2545-55
Who should be decolonized?
  • Recurrent abscess more than 2-3 episodes in a year
  • Decolonization procedure includes mupirocin to nose, bleach or chlorhexidine baths, and sometimes antibiotics that will clear nasopharynx
    • Mupirocin x 5 days
    • 1 cup bleach (teen) or 1/2 cup bleach (child) mixed in entire bath full of water, very brief bath, daily x 5 days
  • Success rates vary from 35-65% (I usually quote 50%)
  • If family members or household contacts should do everyone