What is the treatment for an infected chest wall abscess (abscess) or furuncle (boil)?

From the Guidelines

To treat an infected chest wall boil, incision and drainage is the primary treatment, and antibiotics may be prescribed if there are signs of systemic illness or if the boil does not improve with drainage alone. The most recent and highest quality study, published in 2018 1, recommends that incision and drainage is the primary treatment for simple abscesses or boils, and antibiotics are not needed unless there are signs of systemic illness or the boil does not improve with drainage alone.

Key Considerations

• The boil should be drained by a healthcare provider to prevent further infection and promote healing.
• Antibiotics such as cephalexin or clindamycin may be prescribed if there are signs of systemic illness, such as fever, or if the boil does not improve with drainage alone.
• While waiting for medical care, apply warm compresses to the area for 15 minutes, 3-4 times daily to help bring the infection to a head and promote drainage.
• Keep the area clean with gentle soap and water, and cover with a sterile bandage.
• Do not attempt to squeeze or lance the boil yourself as this can spread infection.

Additional Recommendations

• Take over-the-counter pain relievers like acetaminophen or ibuprofen as directed for discomfort.
• Complete the full course of antibiotics even if symptoms improve.
• Return to your doctor if you develop fever over 101°F, increasing redness, swelling, or if the boil doesn't improve within 2-3 days of treatment.
• It is essential to note that boils on the chest are concerning because the infection can potentially spread to deeper tissues or the bloodstream due to the chest's rich blood supply and proximity to vital organs, as highlighted in the 2011 study by the Infectious Diseases Society of America 1.

Treatment Options

• For empirical coverage of CA-MRSA in outpatients with SSTI, oral antibiotic options include clindamycin, trimethoprim-sulfamethoxazole, a tetracycline, and linezolid, as recommended in the 2011 study 1.
• The 2017 study on infectious diseases associated with organized sports and outbreak control 1 also recommends that antibiotic choices should be guided by knowledge of the local patterns of susceptibility of S. aureus, especially local rates of MRSA.

Important Considerations

• The 2014 study on practice guidelines for the diagnosis and management of skin and soft tissue infections 1 emphasizes that furuncles (or “boils”) are infections of the hair follicle, usually caused by S. aureus, and that incision and drainage is the primary treatment for simple abscesses or boils.
• The 2018 study 1 also highlights that empiric therapy for community-acquired MRSA (CA-MRSA) should be recommended for patients at risk for CA-MRSA or who do not respond to first line therapy.

From the Research

Treatment Options for Infected Chest Wall Boil

• The treatment of infected chest wall boils, also known as furuncles or carbuncles, typically involves the use of antibiotics and/or surgical interventions 2.
• A study published in the Cochrane database of systematic reviews found that there is limited evidence to support the use of specific antibiotics over others for the treatment of bacterial folliculitis and boils 2.
• The study compared different oral antibiotics, including cefadroxil, flucloxacillin, azithromycin, cefaclor, cefdinir, and cefalexin, and found that there may be little to no difference in clinical cure rates between these antibiotics 2.
• However, the study noted that the evidence was generally of low or very low certainty, and that further research is needed to determine the most effective treatments for bacterial folliculitis and boils 2.

Antibiotic Treatment

• A randomized clinical trial published in JAMA found that the use of cephalexin plus trimethoprim-sulfamethoxazole did not result in higher rates of clinical resolution of uncomplicated cellulitis compared to cephalexin alone 3.
• The trial suggested that further research may be needed to determine the effectiveness of antimicrobial regimens possessing in vitro MRSA activity for the treatment of uncomplicated cellulitis 3.

Surgical Interventions

• The Cochrane review found that incision and drainage may be a effective treatment for boils, but noted that there is limited evidence to support this conclusion 2.
• The review suggested that further research is needed to determine the effectiveness of surgical interventions for the treatment of bacterial folliculitis and boils 2.