Complex skin and subcutaneous abscesses

Complex skin and subcutaneous abscesses are typically well circumscribed and respond to incision and drainage.
Antibiotic therapy should be used if systemic signs of infection are present, in immunocompromised patients, if source control is incomplete or in cases of abscess with significant cellulitis.
Common sites of origin of complex abscesses may be perineal or perianal, perirectal, and abscesses at intravenous drug injection sites.

If antibiotics are necessary

One of the following antibiotics

Amoxicillin/clavulanate 1.2-2.2 g 8-hourly

Piperacillin/Tazobactam 4.5 g 6-hourly (in critically ill patients)

Ceftriazone 2 g 24-hourly + Metronidazole 500 mg 6-hourly

Cefotaxime 2g 8-hourly + Metronidazole 500 mg 6-hourly


In patients with beta-lactam allergy

Ciprofloxacin 400 mg 8/12-hourly + Metronidazole 500 mg 6- hourly

In patients at risk for CA-MRSA or who do not respond to first line therapy consider anti- MRSA antibiotics

Oral options:

Minocycline100 mg 12-hourly

Trimethoprim and sulfamethoxazole 160/800 mg 12-hourly

Doxycycline 100 mg 12-hourly

Clindamycin 300–600 mg 8-hourly (high resistance rate)

Linezolid 600 mg 12-hourly

Tedizolid 200 mg 24-hourly

Intravenous options:

Vancomycin 25–30 mg/kg loading dose then 15–20 mg/kg/dose 8-hourly

Teicoplanin LD 12 mg/kg 12-hourly for 3 doses, then 6 mg/kg 12-hourly

Tigecycline 100 mg as a single dose, then 50 mg 12-hourly

Linezolid 600 mg 12-hourly

Daptomycin 4–6 mg/kg 24-hourly

Ceftaroline 600 mg 12-hourly

Dalbavancin 1000 mg once followed by 500 mg after 1 week or 1500 mg one dose

Tedizolid 200 mg 24-hourly

Televancin 10 mg/kg 24-hourly