Peri-rectal abscess +/- cellulitis
- Incision/drainage necessary for abscesses.
Usual Pathogens
Polymicrobial:
Anaerobes
Enterobacterales
S. aureus
Group A Streptococci
No systemic symptoms/< 2cm
| Empiric Therapy | Duration | |
|---|---|---|
| Hot compresses |
Mild - no/minimal symptoms/> 2cm
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin-clavulanate | 875mg PO bid | 7-10 days |
Penicillin/amoxicillin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Cefuroxime axetil | 500mg PO bid | 7-10 days |
| + | ||
| Metronidazole | 500mg PO bid |
Moderate-severe
| Empiric Therapy | Duration | |
|---|---|---|
| [Cefazolin | 2g IV q8h | 10 days |
| + | ||
| 500mg IV/PO q12h | ||
| or | ||
| Piperacillin-tazobactam | 3.375g IV q6h | 10 days |
Penicillin and cefazolin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Ceftriaxone | 2g IV daily | 10 days |
| + | ||
| Metronidazole IV/PO | 500mg IV/PO q12h |
MRSA suspected
Mild
| Empiric Therapy | Duration | |
|---|---|---|
| Amoxicillin-clavulanate | 875mg PO bid | 7-10 days |
| + | ||
| TMP/SMX | 1-2 DS tabs PO bid |
Moderate-severe
| Empiric Therapy | Duration | |
|---|---|---|
| [Vancomycin | 15mg/kg IV q12h | 10 days |
| + | ||
| Ceftriaxone | 2g IV daily | |
| + | ||
| 500mg IV/PO q12h | ||
| or | ||
| [Vancomycin | 15mg/kg IV q12h | 10 days |
| + | ||
| Piperacillin-tazobactam] | 3.375g IV q6h |