What is the preferred empiric therapy for a draining lesion on the back of a diabetic patient?

In the case of a draining lesion on the back of a diabetic patient, the preferred empiric therapy is incision and drainage plus clindamycin. This approach addresses both the need for immediate intervention in cases where there is an abscess or localized infection, as the incision and drainage (I&D) facilitate the removal of infected material and relieve pressure, which can help prevent further tissue damage.

Clindamycin is chosen for its effectiveness against a broad spectrum of bacteria, particularly staphylococci and some streptococci that are commonly implicated in skin and soft tissue infections. It is also beneficial in treating infections associated with anaerobic bacteria, which may be more prevalent in certain wound types, especially in diabetic patients whose wounds can often become complicated by polymicrobial infections.

Oral antibiotics alone would not suffice in cases where surgical intervention is necessary, and topical antiseptics do not address the underlying infection adequately. Observation and follow-up without intervention could lead to worsening of the infection, especially given the baseline risk associated with diabetes, making timely and appropriate treatment critical in this scenario.