Please see our Nondiscrimination Abscess incision and drainage. Medically reviewed by Drugs.com. MeSH Many boils can be treated at home. An official website of the United States government. Copyright 2015 by the American Academy of Family Physicians. If your abscess was opened with an Incision and Drainage: Keep the abscess covered 24 hours a day, removing bandages once daily to wash with warm soap and water. KALYANAKRISHNAN RAMAKRISHNAN, MD, ROBERT C. SALINAS, MD, AND NELSON IVAN AGUDELO HIGUITA, MD. Learn the Signs, Overview of Purpuric Rash, a Symptom of Some Conditions, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, How to Get Rid of Dark Circles Permanently. Open Access Emerg Med. Regardless of supplemental post-procedural treatment, all studies demonstrate high rates of clinical cure following I&D. When performing an incision and drainage of an abscess after adequate anesthesia has been achieved, and the skin has been cleansed with an anti-microbial agent, an approximately one centimeter to a half-centimeter incision is made, at the pointing or most fluctuant area of the abscess. Do this once a day until packing is gone. Assessment and Initial Care. Gentle heat will increase blood flow, and speed healing. Abscess drainage is often one of the first procedures a junior doctor will perform. Its administered with a needle into the skin near the roof of the abscess where your doctor will make the incision for drainage. Antibiotics: Take your antibiotics as prescribed until they are gone , even if your swelling has gone down. What Post-Operative Care is needed at Home after the Bartholin's Gland Abscess Drainage surgical procedure? This content is owned by the AAFP. Skin abscesses can be a significant source of morbidity and are frequently encountered by physicians across the country. Methods: A cruciate incision is made through the skin allowing the free drainage of pus. Unauthorized use of these marks is strictly prohibited. Nonsuperficial mild to moderate wound infections can be treated with oral antibiotics. If this dressing becomes soaked with drainage, it will need to be changed. A dressing that gets wet will need to be changed. You may need antibiotics. Practice and instruct in good handwashing and aseptic wound care. Gently pull packing strip out -1 inch and cut with scissors. 2017 May 1;6(5):e77. 15,22,23 The addition of systemic antibiotic therapy is recommended if the patient has signs and symptoms of illness, rapid progression, failure to respond to incision and drainage alone, associated comorbidities or immunosuppression, abscess in . Simple infections are usually monomicrobial and present with localized clinical findings. 2010 Jun;22(3):273-7. doi: 10.1097/MOP.0b013e328339421b. 13120 Biscayne Blvd., North Miami 305-585-9210 Schedule an Appointment. Antibiotic therapy should be continued until features of sepsis have resolved and surgery is completed. Facebook; Twitter; . Posted in Cyst Popping Tagged abscess drainage procedure., abscess drainage videos, abscess healing stages, care after abscess incision and drainage, hard lump after abscess drained, how to drain abscess at home, how to tell if abscess is healing, what to expect after abscess drainage Leave a Comment on Inflamed Abscess Drainage Post . If everything looks good, you may be shown how to care for the wound and change the dressing and inside packing going forward. Accessibility Case Series and Review on Managing Abscesses Secondary to Hyaluronic Acid Soft Tissue Fillers with Recommended Management Guidelines. Also searched were the Cochrane database, Essential Evidence Plus, and the National Guideline Clearinghouse. sharing sensitive information, make sure youre on a federal You may also see pus draining from the site. The Best 8 Home Remedies for Cysts: Do They Work? You may feel resistance as the incision is initiated. After the incision and drainage, gauze packing may be inserted into the opening. DOI: Ludtke H. (2019). 2021 Jul 27;13:335-341. doi: 10.2147/OAEM.S317713. This fluid drained can be an area of infection such as an abscess or it may be an area of hematoma or seroma. I&D is a time-honored method of draining abscesses to relieve pain and speed healing. We do not discriminate against, Initial antimicrobial choice is empiric, and in simple infections should cover Staphylococcus and Streptococcus species. Rationale: Reduces risk of spread of bacteria. HHS Vulnerability Disclosure, Help The standard treatment for an abscess is an abscess I&D. During this procedure, your general surgeon will numb the surface of your skin, and an incision will be made to drain pus and debris from the boil. After you have an abscess drained, the doctor might prescribe oral antibiotics to help heal your infection. Make an incision directly over the center of the cutaneous abscess; the incision should be oriented along the long axis of the fluid collection. Clipboard, Search History, and several other advanced features are temporarily unavailable. More chronic, complex wounds such as pressure ulcers1 and venous stasis ulcers2 have been addressed in previous articles. This usually depends on the size and severity of the abscess. The recommendations apply to all adults and children with uncomplicated skin abscesses who present to the emergency department or family physician offices, including those with abscesses of all . Patients who undergo this procedure are usually hospitalized. Readily drained abscesses do not benefit from antibiotics after incision, and the surrounding cellulitis of the abscess will be cured with incision and drainage alone. Wound care instructions from your doctor may include wound repacking, soaking, washing, or bandaging for about 7 to 10 days. Plain radiography, ultrasonography, computed tomography, or magnetic resonance imaging may show soft tissue edema or fascial thickening, fluid collections, or soft tissue air. An abscess is a painful infection that can drive many people to the emergency room. Abscess drainage is usually a safe and effective way of treating a bacterial infection of the skin. Infections can be classified as simple (uncomplicated) or complicated (necrotizing or nonnecrotizing), or as suppurative or nonsuppurative. Apply non-stick dressing or pad and tape. During this time, new skin will grow from the bottom of the abscess and from around the sides of the wound. Incision and drainage is the primary therapy for cutaneous abscess management, as antibiotic treatment alone is inadequate for treating many of these loculated collections of infectious material . If your doctor placed gauze wick packing inside of the abscess cavity, your doctor will need to remove or repack this within a few days. Incision and drainage are the standard of care for breast abscesses. Hearns CW. You may also be advised to gently clean the area with soap and warm water before putting on new dressing. This is most commonly caused by a bacterial infection and can occur anywhere on the body. An RCT of 426 patients with uncomplicated wounds found significantly lower infection rates with topical bacitracin, neomycin/bacitracin/polymyxin B, or silver sulfadiazine (Silvadene) compared with topical petrolatum (5.5%, 4.5%, 12.1%, and 17.6%, respectively).22, Topical silver-containing ointments and dressings have been used to prevent wound infections. 49 0 obj <> endobj Abscess Drainage. The observational studies demonstrated mixed results regarding rates of treatment cure with appropriate antibiotic selection, specifically in patients with positive wound cultures for MRSA. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Epub 2015 Feb 20. The most obvious symptom of an abscess is a painful, compressible area of skin that may look like a large pimple or even an open sore. Always follow your healthcare professional's instructions. A doctor will numb the area around the abscess, make a small incision, and allow the pus inside to drain. The American Burn Association has created criteria to help determine when referral is recommended (available at https://www.aafp.org/afp/2012/0101/p25.html#afp20120101p25-t4).29. Your healthcare provider can drain a perineal abscess. Data Sources: A PubMed search was completed in Clinical Queries using the key terms wound care, laceration, abrasion, burn, puncture wound, bite, treatment, and identification. Healing could take a week or two, depending on the size of the abscess. Immediate hospitalization for intravenous antibiotics and referral for surgical debridement are required.28, Patients with severe, full-thickness, or circumferential burns, or those that affect the appendages or face should be referred to a burn center, if available. A warm, wet towel applied for 20 minutes several times a day is enough. The abscess after some time will look raw and will at some point stop draining pus. You can pull the dirty gauze out, and gently tuck a fresh strip of ribbon gauze (use one-quarter inch width ribbon gauze for most abscesses, which you can buy at a drugstore) inside the wound. The fluid and pus are then expressed from the wound. Pain and redness at the wound should improve day to day. You may have gauze in the cut so that the abscess will stay open and keep draining. Often, this is performed in an operating theatre setting; however, this may lead to high treatment costs due to theatre access issues or unnecessary postoperative stay. The skin around the abscess may look red and feel tender and warm. Follow up with your healthcare provider, or as advised. Wounds often become colonized by normal skin flora (gram-positive cocci, gram-negative bacilli, and anaerobes), but most immunocompetent patients will not develop an infection. There is no evidence that prophylactic antibiotics improve outcomes for most simple wounds. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. This article reviews common questions associated with wound healing and outpatient management of minor wounds (Table 1). See permissionsforcopyrightquestions and/or permission requests. You may use acetaminophen or ibuprofen to control pain, unless another pain medicine was prescribed. You see pus (which is usually a sign of infection). An abscess appears like a large and deep bump or mass within or underneath the tissue of the body. This causes an infection and inflammation along with pain and redness. Make sure to properly clean your hands with soap or even disinfectants if necessary. If a gauze packing was placed inside the abscess pocket, you may be told to remove it yourself. It is normal to see drainage (bloody, yellow, greenish) from the wound as long as the wound is open. However, you should check with your doctor or a nurse about home care. stream This allows the tissue to heal properly from inside out and helps absorb pus or blood during the healing process. <>>> This may also help reduce swelling and start the healing. Once the abscess has been located, the surgeon drains the pus using the needle. Fournier gangrene (necrotizing fasciitis) is a surgical emergency and requires prompt hemodynamic resuscitation, broad spectrum antibiotics, and . For severe infections with potential methicillin-resistant S. aureus involvement, treatment should start with linezolid (Zyvox), daptomycin (Cubicin), or vancomycin.30, Puncture Wounds. Alternatively, a longitudinal incision centered on the volar pad can be performed. DISCHARGE INSTRUCTIONS: Contact your healthcare provider if: The area around your abscess has red streaks or is warm and painful. Inpatient treatment is recommended for patients with uncontrolled SSTIs despite adequate oral antibiotic therapy; those who cannot tolerate oral antibiotics; those who require surgery; those with initial severe or complicated SSTIs; and those with underlying unstable comorbid illnesses or signs of systemic sepsis. Rhle A, Oehme F, Brnert K, Fourie L, Babst R, Link BC, Metzger J, Beeres FJ. An abscess can also form after treatment if you develop a methicillin-resistant Staphylococcus aureus (MRSA) infection or other bacterial infection. Penetrating wounds from bites or other materials may introduce other types of bacteria. Repeat this step until the drainage has stopped. First, depending on the size and depth of the cyst or abscess, the physician will bandage the wound with sterile gauze or will insert a drain to allow the abscess to continue draining as it heals. Consensus guidelines recommend trimethoprim/sulfamethoxazole or tetracycline if methicillin-resistant S. aureus infection is suspected,30 although a Cochrane review found insufficient evidence that one antibiotic was superior for treating methicillin-resistant S. aureuscolonized nonsurgical wounds.36, Moderate wound infections in immunocompromised patients and severe wound infections usually require parenteral antibiotics, with possible transition to oral agents.30,31 The choice of agent should be based on the potentially causative organism, history, and local antibiotic resistance patterns. Lymphatic and hematogenous dissemination causes septicemia and spread to other organs (e.g., lung, bone, heart valves). Nondiscrimination Intravenous antibiotics should be continued until the clinical picture improves, the patient can tolerate oral intake, and drainage or debridement is completed. A perineal abscess is a painful, pus-filled bump near your anus or rectum. Healthline Media does not provide medical advice, diagnosis, or treatment. Most severe wound infections, and moderate infections in high-risk patients, require initial parenteral antibiotics, with transition to oral antibiotics after therapeutic response. After incision and drainage, treat with antistaphylococcal antibiotics and warm soaks and have frequent follow-up visits. Along with the causes of dark, Split nails are often caused by an injury such as a stubbed toe or receiving a severe blow to a finger or thumb. Diagnostic testing should be performed early to identify the causative organism and evaluate the extent of involvement, and antibiotic therapy should be commenced to cover possible pathogens, including atypical organisms that can cause serious infections (e.g., resistant gram-negative bacteria, anaerobes, fungi).5, Specific types of SSTIs may result from identifiable exposures. 18910 South Dixie Hwy., Cutler Bay 305-585-9230 Schedule an Appointment. The above information is an educational aid only. The choice is based on the presumptive infecting organisms (e.g., Aeromonas hydrophila, Vibrio vulnificus, Mycobacterium marinum).5, In patients with at least one prior episode of cellulitis, administering prophylactic oral penicillin, 250 mg twice daily for six months, reduces the risk of recurrence for up to three years by 47%.38. Copyright 2023 American Academy of Family Physicians. Persons with hearing or speech disabilities may contact us via their preferred Telecommunication Relay The procedure is typically done on an outpatient basis. Incision and drainage of the skin abscess either under local or general anaesthesia remain the gold standard of treatment [2]. Tissue adhesives are equally effective for low-tension wounds with linear edges that can be evenly approximated. Evaluating the extent and severity of the infection will help determine the proper treatment course. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. The most reliable way to remove a cyst is to have your doctor do it. For the first few days after the procedure, you may want to apply a warm, dry compress (or heating pad set to low) over the wound three or four times per day. Antibiotics may be given to help prevent or fight infection. 2013 Sep;48(9):1962-5. doi: 10.1016/j.jpedsurg.2013.01.027. YL{54| 7400 NW 104th Ave., Doral 305-585-9250 Schedule an Appointment. The gauze dressing on the skin over the wound incision may need to be in place for a couple of days or a week for an abscess that was especially large or deep. It is the primary treatment for skin and soft tissue abscesses, with or without adjunctive antibiotic therapy. 4 0 obj Diabetic lower limb infections, severe hospital-acquired infections, necrotizing infections, and head and hand infections pose higher risks of mortality and functional disability.9, Patients with simple SSTIs present with erythema, warmth, edema, and pain over the affected site. Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years. If so, it should be removed in 1 to 2 days, or as advised. Based on 2013 data from the CDC, cutaneous abscesses . Older age, cardiopulmonary or hepatorenal disease, diabetes mellitus, debility, immunosenescence or immunocompromise, obesity, peripheral arteriovenous or lymphatic insufficiency, and trauma are among the risk factors for SSTIs (Table 2).911 Outbreaks are more common among military personnel during overseas deployment and athletes participating in close-contact sports.12,13 Community-acquired MRSA causes infection in a wide variety of hosts, from healthy children and young adults to persons with comorbidities, health care professionals, and persons living in close quarters. Do I need antibiotics after abscess drainage? Patients with complicated infections, including suspected necrotizing fasciitis and gangrene, require empiric polymicrobial antibiotic coverage, inpatient treatment, and surgical consultation for. Blockage of nipple ducts because of scarring can also cause breast abscesses. government site. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Careers. Common simple SSTIs include cellulitis, erysipelas, impetigo, ecthyma, folliculitis, furuncles, carbuncles, abscesses, and trauma-related infections6 (Figures 1 through 3). The recommended duration of antibiotic therapy for hospitalized patients is seven to 14 days. Three randomized control trials (RCT) and one observational study investigated wound packing versus no packing following I&D. Check your wound every day for any signs that the infection is getting worse. endobj Clean area with soap and water in shower. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you. Patient information: See related handout on wound care, written by the authors of this article. However, there are several reasons for hospitalization or referral (Table 3).2830,36,38,39, Patients with severe wound infections may require treatment with intravenous antibiotics, with possible referral for exploration, incision, drainage, imaging, or plastic surgery.38,39, Necrotizing fasciitis is a rare but life-threatening infection that may result from traumatic or surgical wounds. Recovery time from abscess drainage depends on the location of the infection and its severity. If a gauze packing was placed inside the abscess pocket, you may be told to remove it yourself. Prior to making an incision, your doctor will clean and sterilize the affected area. The role of adjunctive antibiotics in the treatment of skin and soft tissue abscesses: a systematic review and meta-analysis. Simply use a dressing gauze that can be purchased from any pharmacy . Change the dressing if it becomes soaked with blood or pus. 2022 Darst Dermatology: Charlotte Dermatologist, 2 Convenient Locations - South Charlotte & Monroe, NC. A systematic review of 11 studies comparing tissue adhesive with standard wound closure for acute lacerations found that tissue adhesives are less painful and require less procedure time.17 The review found no difference in cosmetic outcomes; however, there was a small but statistically significant increased rate of dehiscence and erythema with tissue adhesives. Then remove your bandage and cleanse the wound with soap and water 1-2 times daily. Antiseptics are commonly used to irrigate contaminated wounds. A mini surgical incision is made through the skin. Lack of purulent drainage or inflammation, Cellulitis extending less than 2 cm from the wound and at least two of the following: erythema, induration, pain, purulence, tenderness, or warmth; limited to skin or superficial tissues; no evidence of systemic illness, Abscess without surrounding cellulitis: incision and drainage, destruction of loculations, dry dressing, Superficial infections (e.g., impetigo, abrasions, lacerations): topical mupirocin (Bactroban); bacitracin and neomycin less effective, Deeper infections: oral penicillin, first-generation cephalosporin, macrolide, or clindamycin, Topical mupirocin, oral trimethoprim/sulfamethoxazole, or oral tetracycline for MRSA, At least one of the following: cellulitis extending 2 cm or more from wound; deep tissue abscess; gangrene; involvement of fascia; lymphangitis; evidence of muscle, tendon, joint, or bone involvement, Cellulitis: five-day course of penicillinase-resistant penicillin or first-generation cephalosporin; clindamycin or erythromycin for patients allergic to penicillin, Bite wounds: five- to 10-day course of amoxicillin/clavulanate (Augmentin); doxycycline or trimethoprim/sulfamethoxazole, or fluoroquinolone plus clindamycin for patients allergic to penicillin, Trimethoprim/sulfamethoxazole for MRSA; patients who are immunocompromised or at risk of noncompliance may require parenteral antibiotics, Acidosis, fever, hyperglycemia, hypotension, leukocytosis, mental status changes, tachycardia, vomiting, In most cases, hospitalization and initial treatment with parenteral antibiotics, Cellulitis: penicillinase-resistant penicillin, first-generation cephalosporin, clindamycin, or vancomycin, Bite wounds: ampicillin/sulbactam (Unasyn), ertapenem (Invanz), or doxycycline, Linezolid (Zyvox), daptomycin (Cubicin), or vancomycin for cellulitis with MRSA; ampicillin/sulbactam or cefoxitin for clenched-fist bite wounds, Progressive infection despite empiric therapy, Spreading of infection, new symptoms (e.g., fever, metabolic instability), Treatment should be guided by results of Gram staining and cultures, along with drug sensitivities, Vancomycin, linezolid, or daptomycin for MRSA; consider switching to oral trimethoprim/sulfamethoxazole if wound improves, Treatment for an infected wound should begin with cleansing the area with sterile saline. We reviewed available literature for any published observational or randomized control trials on the treatment of abscesses via packing and antibiotics. The site is secure. Smaller abscesses may not need to be drained to disappear. The wound will take about 1 to 2 weeks to heal depending on the size of the cyst. Uncomplicated purulent SSTIs in easily accessible areas without overlying cellulitis can be treated with incision and drainage only; antibiotic therapy does not improve outcomes. Avoid antibiotics and wound cultures in emergency department patients with uncomplicated skin and soft tissue abscesses after successful incision and drainage and with adequate medical follow-up. The operation is performed under general anaesthesia. Stopping your antibiotics too early may increase your risk of having the infection return. A recent study suggested that, for small uncomplicated skin abscesses, antibiotics after incision and drainage improve the chance of short term cure compared with placebo. & Accessibility Requirements and Patients' Bill of Rights. Cover the wound with a clean dry dressing. Most severe infections, and moderate infections in high-risk patients, require initial parenteral antibiotics. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. CJEM. sexual orientation, gender, or gender identity. These infections are contagious and can be acquired in a hospital setting or through direct contact with another person who has the infection. The infection may also originate from an adjacent site or from embolic spread from a distant site. 2005-2023 Healthline Media a Red Ventures Company. Care for Your Open Wound, or Draining Abscess Careful attention will help your wound heal smoothly. Epub 2020 Aug 1. A Cochrane review did not establish the superiority of any one pathogen-sensitive antibiotic over another in the treatment of MRSA SSTI.35 Intravenous antibiotics may be continued at home under close supervision after initiation in the hospital or emergency department.36 Antibiotic choices for severe infections (including MRSA SSTI) are outlined in Table 6.5,27, For polymicrobial necrotizing infections; safety of imipenem/cilastatin in children younger than 12 years is not known, Common adverse effects: anemia, constipation, diarrhea, headache, injection site pain and inflammation, nausea, vomiting, Rare adverse effects: acute coronary syndrome, angioedema, bleeding, Clostridium difficile colitis, congestive heart failure, hepatorenal failure, respiratory failure, seizures, vaginitis, Children 3 months to 12 years: 15 mg per kg IV every 12 hours, up to 1 g per day, Children: 25 mg per kg IV every 6 to 12 hours, up to 4 g per day, Children: 10 mg per kg (up to 500 mg) IV every 8 hours; increase to 20 mg per kg (up to 1 g) IV every 8 hours for Pseudomonas infections, Used with metronidazole (Flagyl) or clindamycin for initial treatment of polymicrobial necrotizing infections, Common adverse effects: diarrhea, pain and thrombophlebitis at injection site, vomiting, Rare adverse effects: agranulocytosis, arrhythmias, erythema multiforme, Adults: 600 mg IV every 12 hours for 5 to 14 days, Dose adjustment required in patients with renal impairment, Rare adverse effects: abdominal pain, arrhythmias, C. difficile colitis, diarrhea, dizziness, fever, hepatitis, rash, renal insufficiency, seizures, thrombophlebitis, urticaria, vomiting, Children: 50 to 75 mg per kg IV or IM once per day or divided every 12 hours, up to 2 g per day, Useful in waterborne infections; used with doxycycline for Aeromonas hydrophila and Vibrio vulnificus infections, Common adverse effects: diarrhea, elevated platelet levels, eosinophilia, induration at injection site, Rare adverse effects: C. difficile colitis, erythema multiforme, hemolytic anemia, hyperbilirubinemia in newborns, pulmonary injury, renal failure, Adults: 1,000 mg IV initial dose, followed by 500 mg IV 1 week later, Common adverse effects: constipation, diarrhea, headache, nausea, Rare adverse effects: C. difficile colitis, gastrointestinal hemorrhage, hepatotoxicity, infusion reaction, Adults and children 12 years and older: 7.5 mg per kg IV every 12 hours, For complicated MSSA and MRSA infections, especially in neutropenic patients and vancomycin-resistant infections, Common adverse effects: arthralgia, diarrhea, edema, hyperbilirubinemia, inflammation at injection site, myalgia, nausea, pain, rash, vomiting, Rare adverse effects: arrhythmias, cerebrovascular events, encephalopathy, hemolytic anemia, hepatitis, myocardial infarction, pancytopenia, syncope, Adults: 4 mg per kg IV per day for 7 to 14 days, Common adverse effects: diarrhea, throat pain, vomiting, Rare adverse effects: gram-negative infections, pulmonary eosinophilia, renal failure, rhabdomyolysis, Children 8 years and older and less than 45 kg (100 lb): 4 mg per kg IV per day in 2 divided doses, Children 8 years and older and 45 kg or more: 100 mg IV every 12 hours, Useful in waterborne infections; used with ciprofloxacin (Cipro), ceftriaxone, or cefotaxime in A. hydrophila and V. vulnificus infections, Common adverse effects: diarrhea, photosensitivity, Rare adverse effects: C. difficile colitis, erythema multiforme, liver toxicity, pseudotumor cerebri, Adults: 600 mg IV or orally every 12 hours for 7 to 14 days, Children 12 years and older: 600 mg IV or orally every 12 hours for 10 to 14 days, Children younger than 12 years: 10 mg per kg IV or orally every 8 hours for 10 to 14 days, Common adverse effects: diarrhea, headache, nausea, vomiting, Rare adverse effects: C. difficile colitis, hepatic injury, lactic acidosis, myelosuppression, optic neuritis, peripheral neuropathy, seizures, Children: 10 to 13 mg per kg IV every 8 hours, Used with cefotaxime for initial treatment of polymicrobial necrotizing infections, Common adverse effects: abdominal pain, altered taste, diarrhea, dizziness, headache, nausea, vaginitis, Rare adverse effects: aseptic meningitis, encephalopathy, hemolyticuremic syndrome, leukopenia, optic neuropathy, ototoxicity, peripheral neuropathy, Stevens-Johnson syndrome, For MSSA, MRSA, and Enterococcus faecalis infections, Common adverse effects: headache, nausea, vomiting, Rare adverse effects: C. difficile colitis, clotting abnormalities, hypersensitivity, infusion complications (thrombophlebitis), osteomyelitis, Children: 25 mg per kg IM 2 times per day, For necrotizing fasciitis caused by sensitive staphylococci, Rare adverse effects: anaphylaxis, bone marrow suppression, hypokalemia, interstitial nephritis, pseudomembranous enterocolitis, Adults: 2 to 4 million units penicillin IV every 6 hours plus 600 to 900 mg clindamycin IV every 8 hours, Children: 60,000 to 100,000 units penicillin per kg IV every 6 hours plus 10 to 13 mg clindamycin per kg IV per day in 3 divided doses, For MRSA infections in children: 40 mg per kg IV per day in 3 or 4 divided doses, Combined therapy for necrotizing fasciitis caused by streptococci; either drug is effective in clostridial infections, Adverse effects from penicillin are rare in nonallergic patients, Common adverse effects of clindamycin: abdominal pain, diarrhea, nausea, rash, Rare adverse effects of clindamycin: agranulocytosis, elevated liver enzyme levels, erythema multiforme, jaundice, pseudomembranous enterocolitis, Children: 60 to 75 mg per kg (piperacillin component) IV every 6 hours, First-line antimicrobial for treating polymicrobial necrotizing infections, Common adverse effects: constipation, diarrhea, fever, headache, insomnia, nausea, pruritus, vomiting, Rare adverse effects: agranulocytosis, C. difficile colitis, encephalopathy, hepatorenal failure, Stevens-Johnson syndrome, Adults: 10 mg per kg IV per day for 7 to 14 days, For MSSA and MRSA infections; women of childbearing age should use 2 forms of birth control during treatment, Common adverse effects: altered taste, nausea, vomiting, Rare adverse effects: hypersensitivity, prolonged QT interval, renal insufficiency, Adults: 100 mg IV followed by 50 mg IV every 12 hours for 5 to 14 days, For MRSA infections; increases mortality risk; considered medication of last resort, Common adverse effects: abdominal pain, diarrhea, nausea, vomiting, Rare adverse effects: anaphylaxis, C. difficile colitis, liver dysfunction, pancreatitis, pseudotumor cerebri, septic shock, Parenteral drug of choice for MRSA infections in patients allergic to penicillin; 7- to 14-day course for skin and soft tissue infections; 6-week course for bacteremia; maintain trough levels at 10 to 20 mg per L, Rare adverse effects: agranulocytosis, anaphylaxis, C. difficile colitis, hypotension, nephrotoxicity, ototoxicity.
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