Abscess

Staphylococcus aureus 

Other pathogens depending on specific exposures/risk factors 

Incision and drainage (I&D) is recommended for source control, though previous recommendations suggested I&D alone as an option for small abscesses without surrounding cellulitis, more recent studies have shown faster resolution when antibiotic therapy is given following I&D   

Outpatient/non-severe infection: 

Cephalexin  
25 mg/kg/dose (max 500 mg/dose) enterally tid  

------------------------- 

Inpatient/need for IV therapy: 

Cefazolin
25 mg/kg/dose (max 2000 mg/dose) IV q8h  

Severe infection (hemodynamic instability, end-organ dysfunction, or extensive local progression): 

ID consult  

Penicillin or cephalosporin allergy with higher risk for allergic reaction 

OR 

History of documented MRSA infection or carriage within the last 6 months 

OR 

MRSA identified and susceptible to trimethoprim- sulfamethoxazole 

AND 

Age >=1 month:  

Trimethoprim-sulfamethoxazole (Bactrim)
5 mg trimethoprim/kg/dose (max 160 mg trimethoprim/dose) enterally bid 

Severe infection (hemodynamic instability, end-organ dysfunction, or extensive local progression): 

ID consult 

With abscess I&D, send routine bacterial culture, follow-up result and modify therapy as indicated 

Duration: 5 days following source control for non-severe infection