Diagnosis
Rubor, dolor, calor, tumor around the anus. May be a source for Fourniers.
Epidemiologic Risks
Diabetes, neutropenia, Crohn's disease, trauma, (insert your 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 Staphylococcal infections or,
if mixed infection, amoxicillin/clavulanate 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
It can go on to cause a fistula.
Rants
Antibiotics alone are inadequate and inappropriate.
Last Update: 12/18/18.