care after abscess incision and drainagecare after abscess incision and drainage

$U? An abscess can also form after treatment if you develop a methicillin-resistant Staphylococcus aureus (MRSA) infection or other bacterial infection. Simply use a dressing gauze that can be purchased from any pharmacy . Wound care instructions from your doctor may include wound repacking, soaking, washing, or bandaging for about 7 to 10 days. Our website services, content, and products are for informational purposes only. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). You may do this in the shower. Unauthorized use of these marks is strictly prohibited. Percutaneous abscess drainage is generally used to remove infected fluid from the body, most commonly in the abdomen and pelvis. Treatment of necrotizing fasciitis involves early recognition and surgical debridement of necrotic tissue, combined with high-dose broad-spectrum intravenous antibiotics. There is no evidence that any pathogen-sensitive antibiotic is superior to another in the treatment of MRSA SSTIs. Certain medical conditions or other factors may increase your risk of perineal abscesses. Incision and drainage are required for definitive treatment; antibiotics alone are not sufficient. 18910 South Dixie Hwy., Cutler Bay 305-585-9230 Schedule an Appointment. Avoid antibiotics and wound cultures in emergency department patients with uncomplicated skin and soft tissue abscesses after successful incision and drainage and with adequate medical follow-up. Perianal abscess requires formal incision of the abscess to allow drainage of the pus. 2 0 obj You may have gauze in the cut so that the abscess will stay open and keep draining. Tap water and sterile saline irrigation of uncomplicated skin lacerations appear to be equally effective. 2017 May 1;6(5):e77. Penetrating wounds from bites or other materials may introduce other types of bacteria. Antiseptics are commonly used to irrigate contaminated wounds. government site. But you may not need them to treat a simple abscess. Doral Urgent Care. Within a week, your doctor will remove the dressing and any inside packing to examine the wound during a follow-up appointment. After I&D, instruct the patient to watch for signs of cellulitis or recollection of pus. Copyright 2023 American Academy of Family Physicians. This causes an infection and inflammation along with pain and redness. Doxycycline, tri-methoprim/sulfamethoxazole, or a fluoroquinolone plus clindamycin should be used in patients who are allergic to penicillin.30 For severe infections, parenteral ampicillin/sulbactam (Unasyn), cefoxitin, or ertapenem (Invanz) should be used. Post-Operative Instructions after Incision And Drainage of a Dental Infection (Abscess) - 2 - What medications do I need to take? Less commonly, percutaneous abscess drainage may be used . Wounds often become colonized by normal skin flora (gram-positive cocci, gram-negative bacilli, and anaerobes), but most immunocompetent patients will not develop an infection. Resources| Superficial mild infections can be treated with topical antibiotics; other infections require oral or intravenous antibiotics. %PDF-1.6 % 2020 Nov;13(11):37-43. Patients with complicated infections, including suspected necrotizing fasciitis and gangrene, require empiric polymicrobial antibiotic coverage, inpatient treatment, and surgical consultation for. Human bite wounds may include streptococci, S. aureus, and Eikenella corrodens, in addition to many anaerobes.30 For mild to moderate infections, a five- to 10-day course of oral amoxicillin/clavulanate (Augmentin) is preferred. If it is covered in pus and blood, that is good, because it means that the abscess is draining well. The American Burn Association has created criteria to help determine when referral is recommended (available at https://www.aafp.org/afp/2012/0101/p25.html#afp20120101p25-t4).29. The abscess may be a result of recent surgery or secondary to an infection such as appendicitis. CB2ft U xf3jpo@0DP*(Q_(^~&i}\"3R T&3vjg-==e>5yw/Ls[?Y]ounY'vj;!f8 BiO59P]R)B}7B\0Dz=vF1lhuGh]G'x(#1#aK Learn more about the differences. (2012). Diagnostic testing should be performed early to identify the causative organism and evaluate the extent of involvement, and antibiotic therapy should be commenced to cover possible pathogens, including atypical organisms that can cause serious infections (e.g., resistant gram-negative bacteria, anaerobes, fungi).5, Specific types of SSTIs may result from identifiable exposures. Immediate hospitalization for intravenous antibiotics and referral for surgical debridement are required.28, Patients with severe, full-thickness, or circumferential burns, or those that affect the appendages or face should be referred to a burn center, if available. The observational studies demonstrated mixed results regarding rates of treatment cure with appropriate antibiotic selection, specifically in patients with positive wound cultures for MRSA. Z48.817 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Sometimes a culture is performed to determine the type of bacteria and which antibiotics will work best. Redness and swelling forms around the sore area. Incision and drainage of abscesses in a healthy host may be the only therapeutic approach necessary. Cover the wound with a clean dry dressing. This content is owned by the AAFP. If so, it should be removed in 1 to 2 days, or as advised. by Health-3/01/2023 02:41:00 AM. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 28 0 R 31 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Boils and pimples are skin conditions that can have similar symptoms, but causes and treatments vary. https://www.aafp.org/afp/2014/0815/p239.html. The incision site may drain pus for a couple of days after the procedure. A consultation with one of our skin care experts is the best way to determine which of these treatments will help brighten your skin and get rid of acne for a long time. Pus is drained out of the abscess pocket. Perianal infections, diabetic foot infections, infections in patients with significant comorbidities, and infections from resistant pathogens also represent complicated infections.8. There is no evidence that antiseptic irrigation is superior to sterile saline or tap water. Bethesda, MD 20894, Web Policies Abscess incision and drainage. Do not put gauze directly over wound. After incision and drainage, treat with antistaphylococcal antibiotics and warm soaks and have frequent follow-up visits. Gently pull packing strip out -1 inch and cut with scissors. Other treatments for mild abscesses include dabbing them with a diluted mixture of tea tree oil and coconut or olive oil. Although it is less invasive, needle aspiration of abscess contents is not recommended . You may use acetaminophen or ibuprofen to control pain, unless another pain medicine was prescribed. Systemic features of infection may follow, their intensity reflecting the magnitude of infection. An abscess doesnt always require medical treatment. Replace Polysporin antibiotic and dressing over wound daily for 1-2 weeks, or until wound is well healed. Do not keep packing in place more than 3 Check your wound every day for any signs that the infection is getting worse. Incision and drainage of cutaneous abscess with or without cavity packing: a systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials. Abscess drainage is often one of the first procedures a junior doctor will perform. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. In the case of lactational breast abscesses, milk drainage is performed to resolve the infection and relieve pain. Skin and soft tissue infections result from microbial invasion of the skin and its supporting structures. A dressing that gets wet will need to be changed. Encourage and provide perineal care. If everything looks good, you may be shown how to care for the wound and change the dressing and inside packing going forward. There is no evidence that antiseptic irrigation is superior to sterile. JMIR Res Protoc. Antibiotics may be given to help prevent or fight infection. <> Older studies in animals and humans suggest that moist wounds had faster rates of re-epithelialization compared with dry wounds.911, Guidelines recommend primary closure of wounds that are clean and have no signs of infection within six to 12 hours of the injury; one study suggests that suturing can be delayed for up to 18 hours.12,13 Wounds to areas with an extensive vascular supply (e.g., head, face) may be closed up to 24 hours from the time of injury.13 Because of the high risk of infection, bite wounds are typically left open unless they are on the face and are potentially disfiguring. The care after abscess I & D, as well as recovery time, will depend on the infection's severity and where it occurred. 2022 Darst Dermatology: Charlotte Dermatologist, 2 Convenient Locations - South Charlotte & Monroe, NC. Therefore, it would be appropriate to bill these more specific incision and drainage codes. Careers. What role do antibiotics have in the treatment of uncomplicated skin abscesses after incision and drainage? exclude or treat people differently because of race, color, national origin, age, disability, sex, If you have a severe bacterial infection, you may need to be admitted to a hospital for additional treatment and observation. Incisions along the radial side of the digit should be avoided to prevent painful scar with pinch maneuvers. The Laboratory Risk Indicator for Necrotizing Fasciitis score uses laboratory parameters to stratify patients into high- and low-risk categories for necrotizing fasciitis (Table 4); a score of 6 or higher is indicative, whereas a score of 8 or higher is strongly predictive (positive predictive value = 93.4%).19, Blood cultures are unlikely to change the management of simple localized SSTIs in otherwise healthy, immunocompetent patients, and are typically unnecessary.20 However, because of the potential for deep tissue involvement, cultures are useful in patients with severe infections or signs of systemic involvement, in older or immunocompromised patients, and in patients requiring surgery.5,21,22 Wound cultures are not indicated in most healthy patients, including those with suspected MRSA infection, but are useful in immunocompromised patients and those with significant cellulitis; lymphangitis; sepsis; recurrent, persistent, or large abscesses; or infections from human or animal bites.22,23 Tissue biopsies, which are the preferred diagnostic test for necrotizing SSTIs, are ideally taken from the advancing margin of the wound, from the depth of bite wounds, and after debridement of necrotizing infections and traumatic wounds. However, you should check with your doctor or a nurse about home care. In one prospective study, beta-hemolytic streptococcus was found to cause nearly three-fourths of cases of diffuse cellulitis.16 S. aureus, P. aeruginosa, enterococcus, and Escherichia coli are the predominant organisms isolated from hospitalized patients with SSTIs.17 MRSA infections are characterized by liquefaction of infected tissue and abscess formation; the resulting increase in tissue tension causes ischemia and overlying skin necrosis. Abscess drainage is the treatment typically used to clear a skin abscess of pus and start the healing process. We avoid using tertiary references. 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. 2000-2022 The StayWell Company, LLC. This may cause the hair around the abscess to part and make the abscess more visible to you. This is most commonly caused by a bacterial infection and can occur anywhere on the body. Gently pull packing strip out -1 inch and cut with scissors. Your wound does not start to heal after a few days. Change the dressing if it becomes soaked with blood or pus. I prefer to use a #15 blade scalpel rather than the traditional #11 bladebut either will work. An incision is made on the breast over the abscess and a sterile instrument is inserted to break open small pockets of pus. Prophylactic antibiotics have little benefit in healthy patients with clean wounds. Antibiotics may have been prescribed if the infection is spreading around the wound. 2010 Jun;22(3):273-7. doi: 10.1097/MOP.0b013e328339421b. 8600 Rockville Pike For very large abscess cavities, you can use additional small incisions. KALYANAKRISHNAN RAMAKRISHNAN, MD, ROBERT C. SALINAS, MD, AND NELSON IVAN AGUDELO HIGUITA, MD. It happens when bacteria get trapped under the skin and start to grow. The wound may drain for the first 2 days. The wound may drain for the first 2 days. The wound will take about 1 to 2 weeks to heal depending on the size of the cyst. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient. Prophylactic systemic antibiotics are not necessary for healthy patients with clean, noninfected, nonbite wounds. An abscess can happen with an insect bite, ingrown hair, blocked oil gland, pimple, cyst, or puncture wound. Large incisions are not necessary to drain breast abscesses. After you have an abscess drained, the doctor might prescribe oral antibiotics to help heal your infection. Antibiotics: Take your antibiotics as prescribed until they are gone , even if your swelling has gone down. Tissue adhesives are not recommended for wounds with complex jagged edges or for those over high-tension areas (e.g., hands, joints).15 Tissue adhesives are easy to use, require no anesthesia and less procedure time, and provide good cosmetic results.1517. Because E. corrodens is resistant to most oral antibiotics, clenched-fist bite wounds should be treated with parenteral ampicillin/sulbactam.30, Burns. U[^Y.!JEMI5jI%fb]!5=oX)>(Llwp6Y!Z,n3y8 gwAlsQrsH3"YLa5 5oS)hX/,e dhrdTi+? Erysipelas: usually over face, ears, or lower legs; distinctly raised inflamed skin, Signs or symptoms of infection,* lymphangitis or lymphadenitis, leukocytosis, Most SSTIs occur de novo, or follow a breach in the protective skin barrier from trauma, surgery, or increased tissue tension secondary to fluid stasis. The doctor may have cut an opening in the abscess so that the pus can drain out. Make sure you wash your hands after changing the packing or cleaning the wound. Epub 2020 Nov 1. <>>> Appointments 216.444.5725. 2021 Jul 27;13:335-341. doi: 10.2147/OAEM.S317713. Immunocompromised patients are more prone to SSTIs and may not demonstrate classic clinical features and laboratory findings because of their attenuated inflammatory response. None of the studies demonstrated a difference in treatment failure rates, recurrence rates, or need for secondary interventions in non-packed wounds; however, packing groups had more pain. A meta-analysis of seven RCTs involving 1,734 patients with simple nonbite wounds found that those who received systemic antibiotics did not have a significantly lower incidence of infection compared with untreated patients.20 An RCT of 922 patients undergoing sterile surgical procedures found no increased incidence of infection and similar healing rates with topical application of white petrolatum to the wound site compared with antibiotic ointment.21 However, several studies have supported the use of prophylactic topical antibiotics for minor wounds. Call 612-273-3780. If the patient is seen in a primary care setting by a provider that is not comfortable in performing these procedures, the patient may be started on antibiotics and referred to a general surgeon for definitive treatment. First, depending on the size and depth of the cyst or abscess, the physician will bandage the wound with sterile gauze or will insert a drain to allow the abscess to continue draining as it heals. A complete blood count, C-reactive protein level, and liver and kidney function tests should be ordered for patients with severe infections, and for those with comorbidities causing organ dysfunction. Before this procedure, patients might need to begin with antibiotic therapy to treat and prevent any other infections. Search dates: February 1, 2014 to September 19, 2014. Superficial mild infections can be treated with topical agents, whereas mild and moderate infections involving deeper tissues should be treated with oral antibiotics. You may do this in the shower. You have increased redness, swelling, or pain in your wound. Duong M, Markwell S, Peter J, Barenkamp S. Ann Emerg Med. Pus forms inside the abscess as the body responds to the bacteria. Perianal Abscess. Apply ice several times a day for 10 to 20 minutes at a time. You may need to return in 1 to 3 days to have the gauze in your wound removed and your wound examined. 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. The operation is performed under general anaesthesia. An abscess is usually a collection of pus made up of living and dead white blood cells, fluid, bacteria, and dead tissue. Randomized Controlled Trial of a Novel Silicone Device for the Packing of Cutaneous Abscesses in the Emergency Department: A Pilot Study. Healthline Media does not provide medical advice, diagnosis, or treatment. 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. An abscess is a painful infection that can drive many people to the emergency room. This usually depends on the size and severity of the abscess. Abscess Drainage. It may be helpful to hold the abscess wall open with a pair of sterile curved hemostats after making the incision to prevent collapse of the cavity once the contents begin to drain.3 The NP then inflates the catheter balloon tip with 2-3 mL of sterile saline until it is securely fitted inside the Bartholin gland ( Photograph 3 ). The above information is an educational aid only. At the very least, a dressing change will be necessary anywhere from a few days to a week after the procedure. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This field is for validation purposes and should be left unchanged. There is limited evidence to suggest one topical agent over another, except in the case of suspected methicillin-resistant Staphylococcus aureus infection, in which mupirocin 2% cream or ointment is superior to other topical agents and certain oral antibiotics.3335, Empiric oral antibiotics should be considered for nonsuperficial mild to moderate infections.30,31 Most infections in nonpuncture wounds are caused by staphylococci and streptococci and can be treated empirically with a five-day course of a penicillinase-resistant penicillin, first-generation cephalosporin, macrolide, or clindamycin. Open Access Emerg Med. Follow up with your healthcare provider, or as advised. Leinwand M, Downing M, Slater D, Beck M, Burton K, Moyer D. J Pediatr Surg. Facebook; Twitter; . Your doctor makes an incision through the numbed skin over the abscess. They may make a small incision in your skin over the abscess, then insert a thin plastic tube called a drainage catheter into it. It is normal to see drainage (bloody, yellow, greenish) from the wound as long as the wound is open. Sometimes draining occurs on its own, but generally it must be opened with the help of a warm compress or by a doctor in a procedure called incision and drainage (I&D). 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.

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