Will Antibiotics Alone Cure Pilonidal Disease

The short answer is “no”, but I’ll explain more.

Often patients with symptoms of pilonidal cysts see a doctor and are put on antibiotics, with hopes that they will alleviate the symptoms. Often, there is not a discussion of exactly what is happening, and what the future will bring – and the patient goes away with the idea that the antibiotics are a definitive treatment for the problem. Unfortunately, this is not the case. The antibiotics may help a flare-up or abscess resolve, but it does not address the cause of the problem, nor the underlying cyst or sinus.

If the antibiotics are successful in resolving the current episode of pain and drainage, then there is no emergency in deciding what to do next. However, the chances are very great that this problem will happen again. Every patient has a different approach to this: some prefer a “wait and see” approach, and others want to be proactive in preventing a recurrence. There is no right or wrong answer to this, as long as you understand the situation. Here is a discussion of how to deal with “minimal disease”, in other words pilonidal disease that is not a dramatic problem, but exists, and may need treatment.

There really isn’t good overall data regarding how many patients with a single abscess or flar-up will go on to future problems, but the literature suggests that it is at least 50%; and probably more as time goes on.

So, if you had one episode of pain from pilonidal disease, and it resolved with antibiotics, it is reasonable to research the situation and decide how you want to proceed. It is OK to wait to see if you have further problems – but it might make sense to research what kind of surgery you would want if it recurs, and where you would want to go for that surgery, so it it acts up again you are prepared.