Antibiotic Management for Skin Abscess and Cellulitis in Patients with CKD

Initial Management Approach

The Infectious Diseases Society of America recommends that all abscesses should be treated with incision and drainage as the primary intervention 1, 4
Systemic antimicrobials are usually unnecessary for simple abscesses after adequate drainage, unless fever or evidence of systemic infection is present, as suggested by the Infectious Diseases Society of America 1
For complex or recurrent abscesses, cultures should be obtained and a 5-10 day course of antibiotics active against the isolated pathogen should be administered, according to the Infectious Diseases Society of America 1, 2

For non-purulent cellulitis in CKD patients, the Infectious Diseases Society of America recommends considering Clindamycin 300-450 mg PO three times daily (no adjustment needed in CKD) 2, 3
For severe infections or when MRSA coverage is needed in CKD patients, the Infectious Diseases Society of America suggests using Vancomycin with careful dose adjustment and therapeutic drug monitoring based on CKD stage 2, 3
Daptomycin 4 mg/kg IV every 24 hours with dose adjustment for CKD is also recommended for severe infections or MRSA coverage in CKD patients, as suggested by the Infectious Diseases Society of America 2

The Infectious Diseases Society of America recommends a duration of therapy for cellulitis of 5 days, extending treatment if infection has not improved 2, 3
For abscesses requiring antibiotics, a 5-10 day course is recommended by the Infectious Diseases Society of America 1

Elevating the affected area to reduce edema is recommended by the Infectious Diseases Society of America 3
Examining interdigital toe spaces for fissuring or scaling that may harbor pathogens is suggested by the Infectious Diseases Society of America 2, 3
Addressing predisposing factors such as edema or underlying cutaneous disorders is recommended by the Infectious Diseases Society of America 2, 3

The Infectious Diseases Society of America advises against the unnecessary use of broad-spectrum antibiotics for simple abscesses after adequate drainage 1
Inadequate source control through incomplete drainage of abscesses should be avoided, as recommended by the Infectious Diseases Society of America and the World Journal of Emergency Surgery 1, 4