›Creates permanent drainage opening
›Setting
›Operating room or procedure room with adequate anesthesia
›Gynecology referral typically required from ED
›When antibiotics are NOT indicated
›Uncomplicated Bartholin abscess adequately drained
›No surrounding cellulitis
›No systemic signs of infection
›Antibiotics NOT routinely indicated; Class IIb recommendation
›Antibiotic indications
›Surrounding cellulitis
›Erythema extending beyond abscess margins
›Systemic signs of infection
›Fever, leukocytosis, tachycardia
›Immunocompromised patient
›Lower threshold for treatment
›Positive STI testing
›N. gonorrhoeae or C. trachomatis on NAAT
›Oral regimens for outpatient treatment
›Amoxicillin-clavulanate
›875/125 mg PO every 12 hours
›Duration 5-7 days
›Covers E. coli, anaerobes, streptococci
›Ciprofloxacin plus metronidazole
›Ciprofloxacin 500 mg PO every 12 hours
›Metronidazole 500 mg PO every 8 hours
›Duration 5-7 days
›Use if penicillin allergy
›TMP-SMX DS plus metronidazole (MRSA concern)
›TMP-SMX DS 1 tablet PO every 12 hours
›Metronidazole 500 mg PO every 8 hours
›Duration 5-7 days
›IV regimens for inpatient treatment
›Ampicillin-sulbactam IV
›3 g IV every 6 hours
›Renal dose adjustment when creatinine clearance <30 ml/min
›Piperacillin-tazobactam IV for severe infection or Pseudomonas risk
›4.5 g IV every 6 hours
›Extended infusion (4 hours) per local protocol
›If MRSA suspected
›Vancomycin IV 15-20 mg/kg every 8-12 hours
›AUC-guided monitoring preferred
›Target AUC/MIC 400-600
›Gonorrhea treatment if NAAT positive
›Ceftriaxone 500 mg IM single dose
›Weight >=150 kg: 1 g IM single dose
›Test of cure in 1-2 weeks if symptoms persist
›Plus azithromycin 1 g PO single dose if chlamydia co-infection or not yet tested
›CDC dual therapy guideline recommendation
›Chlamydia treatment if NAAT positive
›Doxycycline 100 mg PO every 12 hours for 7 days
›Preferred over azithromycin for genital chlamydia
›Azithromycin 1 g PO single dose if adherence concern
›Alternative regimen
›Analgesic ladder
›NSAIDs first-line
›Ibuprofen 400-600 mg PO every 6-8 hours with food
›Naproxen 500 mg PO every 12 hours as alternative
›Acetaminophen adjunct
›500-1000 mg PO every 6 hours
›Maximum 4 g per day
›Short-course opioids for severe post-procedural pain
›Oxycodone 5 mg PO every 4-6 hours PRN
›Limit to 2-3 days
›Avoid in pregnancy first trimester if possible
Necrotizing fasciitis management
›Emergency surgical management
›Immediate surgical debridement
›Wide excision of all necrotic tissue
›Re-exploration at 24-48 hours mandatory
›Broad-spectrum IV antibiotics
›Piperacillin-tazobactam 4.5 g IV every 6 hours
›Plus vancomycin 15-20 mg/kg IV every 8-12 hours
›Plus clindamycin 600-900 mg IV every 8 hours for toxin suppression
›ICU-level resuscitation
›Vasopressors if septic shock
›Serial lactate monitoring