Treatment of Buttock Abscesses in Children

Primary Treatment: Incision and Drainage

The primary treatment for buttock abscesses is incision and drainage, which must be performed regardless of size, and should include thorough evacuation of pus and probing the cavity to break up loculations 1, 2, 3
Simply covering the surgical site with a dry dressing is usually effective, though some clinicians pack it with gauze 3
Antibiotics are generally not needed for simple superficial abscesses after adequate drainage 3

Antibiotics should be added if any of the following are present: temperature >38.5°C, heart rate >100-110 beats/minute, white blood cell count >12,000 cells/µL, extensive surrounding cellulitis, multiple sites of infection, immunocompromised status, or inability to completely drain the abscess 1, 2, 3
The American College of Physicians and the Infectious Diseases Society of America recommend considering antibiotics for patients with systemic signs of infection or those who are immunocompromised 1, 2

Clindamycin is the preferred agent for buttock abscesses because it covers both Staphylococcus aureus (including community-acquired MRSA) and anaerobic bacteria 1, 2, 4
The recommended dosing for clindamycin is 10-13 mg/kg/dose every 6-8 hours, with a maximum of 40 mg/kg/day 1, 2
For a 49kg child, the practical dosing is 600 mg every 8 hours, which is within the recommended range 1, 4

The treatment should last for 5-7 days based on clinical response, with most simple abscesses requiring 5-7 days of treatment 1, 3
Patients with ongoing signs of infection beyond 7 days warrant diagnostic re-evaluation 3

Do not rely on antibiotics alone without drainage, as this will fail regardless of antibiotic choice 3
Do not attempt needle aspiration, as it has a low success rate of 25% and <10% with MRSA infections 3
Monitor for Clostridium difficile-associated diarrhea, as clindamycin carries this risk 3

Buttock/perianal abscesses are considered complex abscesses due to polymicrobial flora including anaerobes from adjacent bowel flora 3, 4
These infections typically involve both aerobic (Staphylococcus aureus) and anaerobic organisms, making clindamycin's dual coverage particularly valuable 4
Broader spectrum coverage with agents like cefoxitin or ampicillin-sulbactam may be considered for axillary or perianal locations if the infection is severe or not responding to initial therapy 3