care after abscess incision and drainage care after abscess incision and drainage

Depending on the size of the abscess, it may also be treated with an antibiotic and 'packed' to help it heal. Incision and Drainage of Abscesses | Procedures | 5MinuteConsult Practice and instruct in good handwashing and aseptic wound care. Billing and Coding: Incision and Drainage of Abscess of Skin Wound care instructions from your doctor may include wound repacking, soaking, washing, or bandaging for about 7 to 10 days. Do not put gauze directly over wound. Medically reviewed by Drugs.com. The recommended duration of antibiotic therapy for hospitalized patients is seven to 14 days. This field is for validation purposes and should be left unchanged. Superficial mild infections can be treated with topical agents, whereas mild and moderate infections involving deeper tissues should be treated with oral antibiotics. If a gauze packing was put in your wound, it should be removed in 1 to 2 days, or as directed. endobj An abscess is sometimes called a boil. Three randomized control trials (RCT) and one observational study investigated wound packing versus no packing following I&D. The fluid and pus are then expressed from the wound. 2023 ICD-10-CM Diagnosis Code Z48.817 - ICD10Data.com For severe infections with potential methicillin-resistant S. aureus involvement, treatment should start with linezolid (Zyvox), daptomycin (Cubicin), or vancomycin.30, Puncture Wounds. Irrigate and get the pus out! At first glance, coding incision and drainage procedures looks pretty straightforward (there are just a . Always follow your healthcare professional's instructions. Penetrating wounds from bites or other materials may introduce other types of bacteria. 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. There is no evidence that antiseptic irrigation is superior to sterile. 98 0 obj <>stream Cats will commonly lick at their wound. Soaking a cloth compress in hot water and Epsom salt and applying it gently to an abscess a few times a day may also help dry it out. Immunocompromised patients are more prone to SSTIs and may not demonstrate classic clinical features and laboratory findings because of their attenuated inflammatory response. According to guidelines from the Infectious Diseases Society of America, initial management is determined by the presence or absence of purulence, acuity, and type of infection.5, Topical antibiotics (e.g., mupirocin [Bactroban], retapamulin [Altabax]) are options in patients with impetigo and folliculitis (Table 5).5,27 Beta-lactams are effective in children with nonpurulent SSTIs, such as uncomplicated cellulitis or impetigo.28 In adults, mild to moderate SSTIs respond well to beta-lactams in the absence of suppuration.16 Patients who do not improve or who worsen after 48 hours of treatment should receive antibiotics to cover possible MRSA infection and imaging to detect purulence.16, Adults: 500 mg orally 2 times per day or 250 mg orally 3 times per day, Children younger than 3 months and less than 40 kg (89 lb): 25 to 45 mg per kg per day (amoxicillin component), divided every 12 hours, Children older than 3 months and 40 kg or more: 30 mg per kg per day, divided every 12 hours, For impetigo; human or animal bites; and MSSA, Escherichia coli, or Klebsiella infections, Common adverse effects: diaper rash, diarrhea, nausea, vaginal mycosis, vomiting, Rare adverse effects: agranulocytosis, hepatorenal dysfunction, hypersensitivity reactions, pseudomembranous enterocolitis, Adults: 250 to 500 mg IV or IM every 8 hours (500 to 1,500 mg IV or IM every 6 to 8 hours for moderate to severe infections), Children: 25 to 100 mg per kg per day IV or IM in 3 or 4 divided doses, For MSSA infections and human or animal bites, Common adverse effects: diarrhea, drug-induced eosinophilia, pruritus, Rare adverse effects: anaphylaxis, colitis, encephalopathy, renal failure, seizure, Stevens-Johnson syndrome, Children: 25 to 50 mg per kg per day in 2 divided doses, For MSSA infections, impetigo, and human or animal bites; twice-daily dosing is an option, Rare adverse effects: anaphylaxis, angioedema, interstitial nephritis, pseudomembranous enterocolitis, Stevens-Johnson syndrome, Adults: 150 to 450 mg orally 4 times per day (300 to 450 mg orally 4 times per day for 5 to 10 days for MRSA infection; 600 mg orally or IV 3 times per day for 7 to 14 days for complicated infections), Children: 16 mg per kg per day in 3 or 4 divided doses (16 to 20 mg per kg per day for more severe infections; 40 mg per kg per day in 3 or 4 divided doses for MRSA infection), For impetigo; MSSA, MRSA, and clostridial infections; and human or animal bites, Common adverse effects: abdominal pain, diarrhea, nausea, rash, Rare adverse effects: agranulocytosis, elevated liver enzyme levels, erythema multiforme, jaundice, pseudomembranous enterocolitis, Adults: 125 to 500 mg orally every 6 hours (maximal dosage, 2 g per day), Children less than 40 kg: 12.5 to 50 mg per kg per day divided every 6 hours, Children 40 kg or more: 125 to 500 mg every 6 hours, Common adverse effects: diarrhea, impetigo, nausea, vomiting, Rare adverse effects: anaphylaxis, hemorrhagic colitis, hepatorenal toxicity, Children 8 years and older and less than 45 kg (100 lb): 4 mg per kg per day in 2 divided doses, Children 8 years and older and 45 kg or more: 100 mg orally 2 times per day, For MRSA infections and human or animal bites; not recommended for children younger than 8 years, Common adverse effects: myalgia, photosensitivity, Rare adverse effects: Clostridium difficile colitis, hepatotoxicity, pseudotumor cerebri, Stevens-Johnson syndrome, Adults: ciprofloxacin (Cipro), 500 to 750 mg orally 2 times per day or 400 mg IV 2 times per day; gatifloxacin or moxifloxacin (Avelox), 400 mg orally or IV per day, For human or animal bites; not useful in MRSA infections; not recommended for children, Common adverse effects: diarrhea, headache, nausea, rash, vomiting, Rare adverse effects: agranulocytosis, arrhythmias, hepatorenal failure, tendon rupture, 2% ointment applied 3 times per day for 3 to 5 days, For MRSA impetigo and folliculitis; not recommended for children younger than 2 months, Rare adverse effects: burning over application site, pruritus, 1% ointment applied 2 times per day for 5 days, For MSSA impetigo; not recommended for children younger than 9 months, Rare adverse effects: allergy, angioedema, application site irritation, Adults: 1 or 2 double-strength tablets 2 times per day, Children: 8 to 12 mg per kg per day (trimethoprim component) orally in 2 divided doses or IV in 4 divided doses, For MRSA infections and human or animal bites; contraindicated in children younger than 2 months, Common adverse effects: anorexia, nausea, rash, urticaria, vomiting, Rare adverse effects: agranulocytosis, C. difficile colitis, erythema multiforme, hepatic necrosis, hyponatremia, rhabdomyolysis, Stevens-Johnson syndrome, Mild purulent SSTIs in easily accessible areas without significant overlying cellulitis can be treated with incision and drainage alone.29,30 In children, minimally invasive techniques (e.g., stab incision, hemostat rupture of septations, in-dwelling drain placement) are effective, reduce morbidity and hospital stay, and are more economical compared with traditional drainage and wound packing.31, Antibiotic therapy is required for abscesses that are associated with extensive cellulitis, rapid progression, or poor response to initial drainage; that involve specific sites (e.g., 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, Inpatient treatment is necessary for patients who have uncontrolled infection despite adequate outpatient antimicrobial therapy or who cannot tolerate oral antibiotics (Figure 6). This content is owned by the AAFP. Incision and drainage (I&D) remains the standard of care; however, significant variability exists in the treatment of abscesses after I&D. Some recent evidence has suggested that routinely performed treatment modalities may not be beneficial. & Accessibility Requirements and Patients' Bill of Rights. See permissionsforcopyrightquestions and/or permission requests. ariahealth.org/programs-and-services/radiology/interventional-radiology/abscess-and-fluid-drainage, saem.org/cdem/education/online-education/m3-curriculum/group-emergency-department-procedures/abscess-incision-and-drainage, mayoclinic.org/diseases-conditions/mrsa/symptoms-causes/syc-20375336, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, How to Get Rid of a Boil: Treating Small and Large Boils, Identifying boils: Differences from cysts and carbuncles, Is It a Boil or a Pimple? 2022 Fairview Health Services. Data Sources: A PubMed search was completed using the key term skin and soft tissue infections. Monomicrobial necrotizing fasciitis caused by streptococcal and clostridial infections is treated with penicillin G and clindamycin; S. aureus infections are treated according to susceptibilities. Author disclosure: No relevant financial affiliations. The Infectious Diseases Society of America uses several clinical indicators to help stage the severity of wounds: those without purulence or inflammation are considered noninfected, and infected wounds are classified as mild, moderate, or severe based on their size and depth, surrounding cellulitis, tissue involvement, and presence of systemic or metabolic findings30,32 (Table 23033 ). Abscess drainage is usually a safe and effective way of treating a bacterial infection of the skin. If a local anesthetic is enough, you may be able to drive yourself home after the procedure. Ideally, make second small (4-5mm) incision within 4 cm of the first. Patients may prefer irrigation with warm fluids. Most simple abscesses can be diagnosed upon clinical examination and safely be managed in the ambulatory office with incision and drainage. & Accessibility Requirements. An abscess can be formed in the skin making it visible or in any part . Many boils can be treated at home. Plain radiography, ultrasonography, computed tomography, or magnetic resonance imaging may show soft tissue edema or fascial thickening, fluid collections, or soft tissue air. Results: Common Questions About Wound Care | AAFP Learn more about the differences. An infected wound will disrupt tissue granulation and delay healing. 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. Perianal Abscess. Current wound care practices recommend maintaining a moist wound bed to aid in healing.7,8 Wounds should be occluded with an appropriate dressing and reassessed periodically for optimal moisture levels. Dog and cat bites in an immunocompromised host and those that involve the face or hand, periosteum, or joint capsule are typically treated with a beta-lactam antibiotic or beta-lactamase inhibitor (e.g., amoxicillin/clavulanate [Augmentin]).5 In patients allergic to penicillin, a combination of trimethoprim/sulfamethoxazole or a quinolone with clindamycin or metronidazole (Flagyl) can be used. Incision and Drainage - StatPearls - NCBI Bookshelf 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. Before More chronic, complex wounds such as pressure ulcers1 and venous stasis ulcers2 have been addressed in previous articles. You can expect a little pus drainage for a day or two after the procedure. Usually, a local anesthetic is sufficient to keep you comfortable. Intravenous antibiotics should be continued until the clinical picture improves, the patient can tolerate oral intake, and drainage or debridement is completed. KALYANAKRISHNAN RAMAKRISHNAN, MD, ROBERT C. SALINAS, MD, AND NELSON IVAN AGUDELO HIGUITA, MD. In contrast, complicated infections can be mono- or polymicrobial and may present with systemic inflammatory response syndrome. Antibiotics for Uncomplicated Skin Abscesses After Incision and Then remove your bandage and cleanse the wound with soap and water 1-2 times daily. Healthy tissue will grow from the bottom and sides of the opening until it seals over. Most severe wound infections, and moderate infections in high-risk patients, require initial parenteral antibiotics, with transition to oral antibiotics after therapeutic response. Clipboard, Search History, and several other advanced features are temporarily unavailable. Percutaneous abscess drainage is generally used to remove infected fluid from the body, most commonly in the abdomen and pelvis. You may have gauze in the cut so that the abscess will stay open and keep draining. Overlaying skin can become especially fragile and be easily torn away, creating a large raw spot. For example, diabetes increases the risk of infection-associated complications fivefold.14 Comorbidities and mechanisms of injury can determine the bacteriology of SSTIs (Table 3).5,15 For instance, Pseudomonas aeruginosa infections are associated with intravenous drug use and hot tub use, and patients with neutropenia more often develop infections caused by gram-negative bacteria, anaerobes, and fungi. Infections can be classified as simple (uncomplicated) or complicated (necrotizing or nonnecrotizing), or as suppurative or nonsuppurative. Six studies investigated the post-procedural use of antibiotics. Abscess Nursing Care Plans Diagnosis and Interventions. Abscess drainage. 1 Abscesses can form anywhere on the body. sexual orientation, gender, or gender identity. Place a maxi pad or gauze in your underwear to absorb drainage from your abscess while it heals. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Redness and swelling forms around the sore area. Keep the area clean and protected from further injury. An abscess appears like a large and deep bump or mass within or underneath the tissue of the body. The doctor may have cut an opening in the abscess so that the pus can drain out. These infections are contagious and can be acquired in a hospital setting or through direct contact with another person who has the infection. Widespread fungal infection is a rare but serious complication of broad-spectrum antibiotic use in burns. 8600 Rockville Pike An incision is made on the breast over the abscess and a sterile instrument is inserted to break open small pockets of pus. In studies of clean surgical incisions, there was no high-quality evidence that one antiseptic was superior to another for preventing wound infections. Care An abscess incision and drainage (I and D) is a procedure to drain pus from an abscess and clean it out so it can heal. These infections may present with features of systemic inflammatory response syndrome or sepsis, and, occasionally, ischemic necrosis. 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. Incision and drainage (I&D) is a widely used procedure in various care settings, including emergency departments and outpatient clinics. The goal of treatment is to eliminate the bacteria without further damage to the underlying tissue. Z48.817 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. PDF Post-Operative Instructions after Incision and Drainage of a Dental After an aspiration or incision and drainage procedure, a few additional steps are taken. Do this as long as you have pain in your anal area. If you have a severe bacterial infection, you may need to be admitted to a hospital for additional treatment and observation. You may feel resistance as the incision is initiated. 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. Milder abscesses may drain on their own or with a variety of home remedies. If the abscess pocket was large, your provider may have put in gauze packing. 75 0 obj <>/Filter/FlateDecode/ID[<872B7A6F2C7DA74D949F559336DF4F28>]/Index[49 50]/Info 48 0 R/Length 121/Prev 122993/Root 50 0 R/Size 99/Type/XRef/W[1 3 1]>>stream If this dressing becomes soaked with drainage, it will need to be changed. While the number of studies is small, there is data to support the elimination of abscess packing and routine avoidance of antibiotics post-I&D in an immunocompetent patient; however, antibiotics should be considered in the presence of high risk features. Randomized Controlled Trial of a Novel Silicone Device for the Packing of Cutaneous Abscesses in the Emergency Department: A Pilot Study. Taking all of your antibiotics exactly as prescribed can help reduce the odds of an infection lingering and continuing to cause symptoms. Abscess incision and drainage. Incision and drainage of cutaneous abscess with or without cavity packing: a systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials. Suturing, if required, can be completed up to 24 hours after the trauma occurs, depending on the wound site. Topical antibiotic ointments decrease the risk of infection in minor contaminated wounds. Only recent manuscripts published in the English language and in the past 10 years (2004 through 2014) were included due to the emergence of methicillin-resistant Staphylococcus aureus (MRSA) as one of the leading causative organism of soft tissue infections in the past decade. Prophylactic systemic antibiotics are not necessary for healthy patients with clean, noninfected, nonbite wounds. 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. by Health-3/01/2023 02:41:00 AM. Other treatments for mild abscesses include dabbing them with a diluted mixture of tea tree oil and coconut or olive oil. Here's What The Healing Stages Of Your Cat's Abscess - Fauna Care 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. Service. Some recent evidence has suggested that routinely performed treatment modalities may not be beneficial. Its administered with a needle into the skin near the roof of the abscess where your doctor will make the incision for drainage. However, if the infection wasnt eliminated, the abscess could reform in the same spot or elsewhere. FOIA Abscess, Incision And Drainage Do not keep packing in place more than 3 If a gauze packing was placed inside the abscess pocket, you may be told to remove it yourself. You may be taught how to change the gauze in your wound. hbbd```b``"A$da`8&A$-}Drt`h hf k5@0{"'t5P0 0r There is no evidence that any pathogen-sensitive antibiotic is superior to another in the treatment of MRSA SSTIs. MRSA infection. Some of the things you can follow on your own are: Keep the abscess area clean. The incision needs to be long enough and deep enough to allow access to the abscess cavity later, when you explore the abscess cavity. Incision and drainage after care? PDF TREATMENT OF YOUR ABSCESS - University of California, Berkeley The skin is left open and the cavity heals from inside out . MeSH How To Incise and Drain an Abscess - Injuries; Poisoning - Merck Tissue adhesives can be used as an alternative for closure of simple, noninfected lacerations in which the wound edges are easily approximated in areas of low tension and moisture. Inflamed Abscess Drainage - New Pimple Popping Videos doi: 10.2196/resprot.7419. Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years. A review of 26 RCTs found insufficient evidence to support these treatments.23 A review of eight RCTs of bites from cats, dogs, and humans found that the use of prophylactic antibiotics significantly reduced infection rates after human bites (odds ratio = 0.02; 95% confidence interval, 0.00 to 0.33), but not after dog or cat bites.24 A Cochrane review found three small trials in which prophylactic antibiotics after bites to the hand reduced the risk of infection from 28% to 2%.24, The Centers for Disease Control and Prevention recommends that tetanus toxoid be administered as soon as possible to patients who have no history of tetanus immunization, who have not completed a primary series of tetanus immunization (at least three tetanus toxoidcontaining vaccines), or who have not received a tetanus booster in the past 10 years.25 Tetanus immunoglobulin is also indicated for patients with puncture or contaminated wounds who have never had tetanus immunization.26, Symptoms of infection may include redness, swelling, warmth, fever, pain, lymphangitis, lymphadenopathy, and purulent discharge.2729 The treatment of wound infections depends on the severity of the infection, type of wound, and type of pathogen involved. 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. They can be drained surgically, carried out under general or local anaesthetic, depending on location of abscess and patient tolerance. Ask the patient to return to clinic only as needed. Care for Your Open Wound, or Draining Abscess Careful attention will help your wound heal smoothly. After the incision and drainage, gauze packing may be inserted into the opening. 13120 Biscayne Blvd., North Miami 305-585-9210 Schedule an Appointment. Abscess Incision and Drainage | NEJM Dressings protect the wound by acting as a barrier to infection and absorbing wound fluid. Based on 2013 data from the CDC, cutaneous abscesses . Bethesda, MD 20894, Web Policies Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. The abscess drainage procedure itself is fairly simple: If it isnt possible to use local anesthetic or the drainage will be difficult, you may need to be placed under sedation, or even general anesthesia, and treated in an operating room. About 1 in 15 of these women can develop breast abscesses. Change thedressing if it becomes soaked with blood or pus. <> The incision and drainage can be performed with local anesthesia. 2021 Jun;406(4):981-991. doi: 10.1007/s00423-020-01941-9. Skin and soft tissue infections result from microbial invasion of the skin and its supporting structures. The lower extremities are most commonly involved.9 Induration is characteristic of more superficial infections such as erysipelas and cellulitis. It will stick to the packing and possibly pull it out at the next dressing change. Within a week, your doctor will remove the dressing and any inside packing to examine the wound during a follow-up appointment. All rights reserved. Hearns CW. Skin and Soft Tissue Infections | AAFP Perianal Abscess: vs. Hemorrhoid, Causes & Treatment, Surgery Will urgent care drain an abscess? Explained by Sharing Culture It involves making an incision into the abscess, breaking down the loculated areas, and washing out the pus as thoroughly as possible. You may do this in the shower. 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.