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
or
In patients with beta-lactam allergy
Ciprofloxacin 400 mg 8/12-hourly + Metronidazole 500 mg 6- hourly
