From the Guidelines
Recurrent boils should be drained and cultured early in the course of infection to identify the causative pathogen and guide antibiotic treatment. This approach is supported by the Infectious Diseases Society of America's 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections 1. When a patient presents with a recurrent boil, it is essential to consider local causes such as a pilonidal cyst, hidradenitis suppurativa, or foreign material, as these may be contributing to the recurrence 1.
Key considerations in the management of recurrent boils include:
- Draining the abscess to obtain material for culture and sensitivity testing
- Initiating antibiotic treatment based on the results of the culture and sensitivity testing, with a recommended course of 5- to 10-day treatment with an antibiotic active against the isolated pathogen 1
- Evaluating adult patients for neutrophil disorders if recurrent abscesses began in early childhood, as this may indicate an underlying immune deficiency 1
In terms of specific testing, the focus should be on identifying the causative organism and assessing for any underlying conditions that may be contributing to the recurrence. This may include:
- Bacterial culture and sensitivity testing of the abscess material
- Nasal swabs to check for Staphylococcus aureus colonization
- Blood tests to assess for underlying conditions such as diabetes or immune disorders
It is crucial to perform testing during an active infection, before starting antibiotics, to ensure accurate results and guide effective treatment 1. By taking a targeted approach to the management of recurrent boils, healthcare providers can reduce the risk of complications, prevent future recurrences, and improve patient outcomes.
From the Research
Testing for Recurrent Boil
- Recurrent furunculosis is a condition characterized by repeated episodes of boils, often caused by Staphylococcus aureus infection 2.
- The CMC regimen, which includes skin disinfection with chlorhexidine, local nasal antibiotic with mupirocin, and systemic antibiotic with clindamycin, has been shown to be effective in treating recurrent furunculosis 2.
- Mupirocin ointment has been used to eradicate Staphylococcus aureus nasal carriage, which is a major risk factor for recurrent boils 3, 4.
- However, the emergence of mupirocin resistance, both high-level and low-level, can reduce the effectiveness of decolonizing strategies for S. aureus or MRSA 5.
- Antimicrobial therapy, such as oral antibiotics, may be necessary to treat recurrent boils, especially if they are caused by methicillin-resistant S. aureus (MRSA) 6, 2.
Diagnosis and Treatment
- Diagnosis of recurrent boils typically involves culturing the affected area to identify the causative bacteria 6, 2.
- Treatment may involve a combination of antimicrobial therapy, incision and drainage, and skin disinfection 6, 2.
- In some cases, nasal carriage of S. aureus may need to be eradicated using mupirocin ointment or other topical antibiotics 3, 4.
- The CMC regimen has been shown to be effective in reducing the recurrence of boils, but more research is needed to determine its long-term efficacy and safety 2.