Infectious Disease Compendium

Perianal abscess

Diagnosis

Rubor, dolor, calor, tumor around the anus. May be a source for Fourniers.

Epidemiologic Risks

Diabetes, neutropenia, trauma, (insert you least favorite political affiliation here).

Microbiology

Either S. aureus OR mixed streptococci plus anaerobes plus E. coli.

Empiric Therapy

Cold steel in the hands of a steady surgeon, is probably is curative, but a 7 - 10 day course of cephalexin OR dicloxacillin for staph infections or, if mixed infection, amox/clav alone OR (TMP/Sulfa OR quinolone PLUS metronidazole OR clindamycin) OR (amoxicillin PLUS metronidazole OR clindamycin).

If ill enough to be admitted, third generation cephalosporins PLUS metronidazole. Alternatives include a carbapenem OR penicillin/beta-lactamase inhibitors OR a quinolone PLUS metronidazole OR clindamycin.

Pearls

Rants

ICD9 Codes (Soon to be supplanted by ICD10)

perineal (superficial) 682.2; deep (with urethral involvement) 597.0.