From the Guidelines
For the treatment of furuncles, incision and drainage is the recommended treatment, especially for large furuncles, and antibiotics may be considered based on the presence of systemic inflammatory response syndrome (SIRS) or markedly impaired host defenses 1. The treatment approach for furuncles, commonly known as boils, typically involves applying warm compresses to the affected area for 10-15 minutes, 3-4 times daily to promote drainage and healing. For small furuncles, this home treatment along with keeping the area clean with mild soap and water is often sufficient. If the boil is large, painful, or doesn't improve within a week, medical treatment may be necessary. Some key points to consider in the treatment of furuncles include:
- Incision and drainage is recommended for large furuncles and carbuncles 1
- Antibiotics may be considered for patients with systemic inflammatory response syndrome (SIRS) or markedly impaired host defenses 1
- An antibiotic active against MRSA is recommended for patients with carbuncles or abscesses who have markedly impaired host defenses and in patients with SIRS 1
- Proper hygiene, including regular handwashing and not sharing personal items, can help prevent recurrence It's also important to note that furuncles occur when hair follicles become infected with bacteria, usually Staphylococcus aureus, resulting in a painful, pus-filled bump. Avoid squeezing or attempting to drain the boil yourself as this can spread the infection. In some cases, oral antibiotics such as dicloxacillin, cephalexin, or clindamycin may be prescribed for 7-10 days, and for MRSA infections, trimethoprim-sulfamethoxazole (Bactrim) or doxycycline may be used 2.
From the Research
Treatment Options for Furuncle
- The treatment for furuncle, also known as a boil, typically involves antibiotics and/or incision and drainage 3.
- A systematic review of 18 randomized controlled trials (RCTs) found that different oral antibiotics, such as cefadroxil, flucloxacillin, azithromycin, and cefaclor, may have similar clinical cure rates for bacterial folliculitis and boils 3.
- However, the review noted that the certainty of the evidence was often low or very low due to the small number of participants and the wide confidence intervals 3.
Antibiotic Selection
- The choice of antibiotic may depend on the suspected causative organism, such as community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) 4, 5.
- Studies have shown that doxycycline and trimethoprim-sulfamethoxazole are effective against CA-MRSA, while clindamycin and levofloxacin may also be effective, but with lower sensitivity rates 4.
- A retrospective cohort study found that trimethoprim-sulfamethoxazole had a higher treatment success rate than cephalexin for outpatient cellulitis, while clindamycin was more effective for patients with culture-confirmed MRSA infections 5.
Incision and Drainage
- Incision and drainage may be necessary for larger or more severe boils, and may be performed in conjunction with antibiotic therapy 3, 4.
- A study found that 47% of participants with furuncles or boils underwent incision and drainage, and that the duration of oral and topical treatments ranged from 3 days to 6 weeks 3.