Skin abscess +/- cellulitis

Usual Pathogens

Group A Streptococci
S. aureus
Group B,C,G Streptococci

Mild

Empiric Therapy Dose Duration
I&D
If any of the following:
  • fever >38°C
  • multiple/extensive lesions
  • surrounding cellulitis
  • clinical failure of/ incomplete I&D
  • immunocompromised
Cephalexin 500-1000mg PO qid 5 days

Cephalexin allergy

Empiric Therapy

Dose

Duration
Cefuroxime axetil 500mg PO bid 5 days

Cephalexin and cefuroxime allergy

Empiric Therapy

Dose

Duration
Clindamycin 300mg PO qid 5 days

If above and risk factors for MRSA:

Empiric Therapy

Dose

Duration
Add TMP/SMX or doxycycline to cephalexin or cefuroxime
TMP/SMX 1-2 DS tabs PO bid 5 days
or    
Doxycycline 100mg PO bid 5 days

 

Moderate-severe

Empiric Therapy

Dose

Duration
I&D    
+    
Cefazolin 2g IV q8h 5-10 days
+    
TMP/SMX 1-2 DS tabs PO bid  

 

Cefazolin allergy

Empiric Therapy

Dose

Duration
I&D    
+    
Vancomycin 15mg/kg IV q12h 5-10 days