I appreciated the article, “‘Drain-O-Mycin’ Still Preferred for Uncomplicated Skin Abscess in MRSA Era,” by Dr. Luis Lovato. (EMN 2011;33:9.) I agree that I&D alone is a sufficient (and preferred) treatment for most abscesses, but I think the bigger issue is the high incidence of recurrence of MRSA-related cellulitis and abscesses.
For this reason, my ID colleagues routinely recommend a longer-than-usual course (up to one month!) of an appropriate antibiotic, often with a side of Rifampin to avoid resistance. I often recommend the use of chlorhexidine washes as well, paying particular attention to areas of colonization (axilla, groin, etc.).
Dr. Lovato pointed out that “additional lesions at 30 days occurred less frequently in the antibiotic group, but this was a secondary outcome limited by large patient dropout.” I have often seen recurrence past 30 days. Is this due to new exposure or reoccurrence related to colonization and unrelated interruption in skin integrity resulting in new cellulitis/abscess?
I look forward to seeing a good study on the incidence of MRSA cellulitis/abscess recurrence and how to prevent it, with or without antibiotics.
Robert Ruggieri MD