Peri-rectal abscess +/- cellulitis

Incision/drainage necessary for abscesses.

 
Usual Pathogens
Polymicrobial:

Group A Streptococci
S. aureus
Anaerobes
Enterobacterales

 

No systemic symptoms/< 2cm

Empiric Therapy Dose Duration
Hot compresses    

Mild - no/minimal symptoms/> 2cm

Empiric Therapy Dose Duration
Amoxicillin-clavulanate 40mg/kg/d PO div tid 7-10 days

Moderate-severe

Empiric Therapy Dose Duration
[Clindamycin 20-40mg/kg/d IV/PO div q8h 10 days
+    
Gentamicin] 7mg/kg IV q24h  
or    
[Cefazolin 75mg/kg/d IV div q8h 10 days
+    
Metronidazole] 30mg/kg/d IV/PO div q12h  

MRSA suspected - Mild

Empiric Therapy Dose Duration
Amoxicillin-clavulanate 40mg/kg/d PO div tid 7-10 days
+    
TMP/SMX (if > 1 month old) 8-12mg TMP/kg/d PO div bid  

MRSA suspected - Moderate-severe

Empiric Therapy Dose Duration
Vancomycin 60mg/kg/d IV div q6h 10 days
+    
Ceftriaxone 50-75mg/kg IV q24h  
+    
Metronidazole 30mg/kg/d IV div q12h