Management of Recurrent Gluteal Abscesses

Initial Management Approach

The Infectious Diseases Society of America (IDSA) recommends draining and culturing the abscess early, then treating with a 5-10 day course of antibiotics active against the isolated pathogen, typically targeting Staphylococcus aureus (including MRSA) with agents such as trimethoprim-sulfamethoxazole, doxycycline, or clindamycin, followed by a 5-day decolonization regimen 1, 2
Recurrent abscesses must be drained and cultured early in the course of infection to identify the causative pathogen and guide antibiotic selection 1, 2, 3
Incision and drainage remains the primary treatment modality for all abscesses 1, 2
Before initiating treatment, search for local causes such as pilonidal cyst, hidradenitis suppurativa, or foreign material that may be perpetuating recurrence 1, 2, 3

Treat with a 5-10 day course of an antibiotic active against the isolated pathogen 1, 2, 3
The IDSA guidelines provide specific antibiotic options for MRSA coverage, including trimethoprim-sulfamethoxazole, doxycycline, or clindamycin 4, 5
For severe infections or systemic signs, consider using vancomycin, linezolid, or daptomycin 4, 5

After treating the acute infection, implement a 5-day decolonization regimen, including intranasal mupirocin, daily chlorhexidine washes, and daily decontamination of personal items 1, 2, 3, 6
The IDSA recommends considering decolonization given the low risk and potential benefit 1, 2

Always use antibiotics in addition to drainage for patients with surrounding cellulitis or erythema >2 cm, immunocompromised patients, or those with systemic signs of infection or SIRS 1, 2, 3, 4, 5

Standard duration of antibiotic therapy is 5-10 days, but treatment should be extended if infection has not improved within this time period 1, 2, 3, 4, 5