What are the recommended antibiotics for a patient with an anorectal abscess, and when should they be prescribed?

Anorectal abscesses primarily require surgical drainage as the main treatment. Antibiotics are not routinely recommended unless there are specific circumstances such as systemic infection, immunosuppression, significant comorbidities, or spreading cellulitis.

When antibiotics are indicated, the choice should cover common pathogens including anaerobic and aerobic bacteria. First-line antibiotics often include co-amoxiclav. For patients allergic to penicillin, alternatives such as metronidazole combined with ciprofloxacin or clarithromycin may be used, but fluoroquinolones like ciprofloxacin should only be prescribed when other options are inappropriate due to risks of serious side effects.

Antibiotics should be prescribed in cases where there is systemic illness, immunosuppression, or significant comorbidity, or if there is spreading cellulitis or failure to improve after drainage. The duration of antibiotic therapy is typically guided by clinical response, and microbiological samples from drained pus should be sent to tailor antibiotic therapy if possible.