Antibiotic therapy is required for abscesses that are associated with extensive cellulitis, rapid progression, or poor response to initial drainage; that involve specific sites (., face, hands, genitalia); and that occur in children and older adults or in those who have significant comorbid illness or immunosuppression. 32 In uncomplicated cellulitis, five days of treatment is as effective as 10 days. 33 In a randomized controlled trial of 200 children with uncomplicated SSTIs primarily caused by MRSA, clindamycin and cephalexin (Keflex) were equally effective. 34
After the incision is made, the Word catheter is inserted, and the balloon tip is inflated with 2 to 3 mL of saline solution injected through the hub of the catheter. The inflated balloon allows the catheter to remain within the cavity of the cyst or abscess ( Figure 3 ). The free end of the catheter can be placed in the vagina. 16 To allow epithelialization of the surgically created tract, the Word catheter is left in place for four to six weeks, 1 , 10 , 16 although epithelialization may occur as soon as three to four weeks. 18
In those cases of abscess which do require antibiotic treatment, Staphylococcus aureus bacteria is a common cause and an anti-staphylococcus antibiotic such as flucloxacillin or dicloxacillin is used. The Infectious Diseases Society of America advises that the draining of an abscess is not enough to address community-acquired methicillin-resistant Staphylococcus aureus (MRSA), and in those cases, traditional antibiotics may be ineffective.  Alternative antibiotics effective against community-acquired MRSA often include clindamycin , doxycycline , minocycline , and trimethoprim-sulfamethoxazole .  The American College of Emergency Physicians advises that typical cases of abscess from MRSA get no benefit from having antibiotic treatment in addition to the standard treatment.  If the condition is thought to be cellulitis rather than abscess, consideration should be given to possibility of strep species as cause that are still sensitive to traditional anti-staphylococcus agents such as dicloxacillin or cephalexin in patients able to tolerate penicillin. Antibiotic therapy alone without surgical drainage of the abscess is seldom effective due to antibiotics often being unable to get into the abscess and their ineffectiveness at low pH levels.