When the kinds of bacteria in pilonidal cysts or abscesses are determined, we find that the majority of them are “anaerobic bacteria”, which are the kind of bacteria that thrive in an environment without oxygen. This is why the antibiotics that we give orally before and after cleft-lift surgery are specifically chosen to target that kind of bacteria.
There are times after surgery that we want the lower portion of the wound, which is near the anus, to have more prolonged anaerobic bacteria coverage, and have found that metronidazole ointment works well for this. Unfortunately, the strengths of topical metronidazole easily available in the United States come in very weak strengths (0.75% or 1%). In Europe they have a 10% metronidazole ointment, called Ortem, but this is not approved for use here in the U.S. This has been shown in various studies to be very effective in treating pilonidal disease in some situations.
Our solution to this is to have a compounding pharmacy make 10% metronidazole for us, using FDA approved components. If I have prescribed this for you, we will call the order into a compounding pharmacy, and they will make it up for you, bill you, and send it directly to you. Unfortunately, this may not be covered by your insurance, and may cost around $85.
The usual recommendation is to use this for six to eight weeks – but if your wound looks good, and we have complete healing before then, it may not be necessary to use it for that long.
We use this for:
- post op wounds that are at great risk for problems because of their perianal location.
- post op incisions that develop some degree of separation and are next to the anus.
- recurrent pilonidal disease that manifests itself with a small wound next to the anus.
- wounds between the anus and scrotum (on the perineum).
- put a small amount on the part of the scar near the anus or whichever area is having trouble healing. You don’t have to put it on the entire incision.
- Apply twice a day
- Keep a gauze pad tucked in between the cheeks next to the ointment.
- Don’t shower and wash it away within about 4 hours. If you do, just re-apply.
Any questions not answered here? Just ask us!