From the Guidelines
For the treatment of a boil, incision and drainage is the primary treatment, and antibiotic therapy is usually unnecessary unless there is extensive surrounding cellulitis or fever, in which case clindamycin or other antibiotics may be considered 1.
Treatment Approach
When treating a boil, the following approach can be taken:
- For small furuncles, moist heat can be applied to promote drainage, and this may be sufficient for treatment 1.
- For larger furuncles and carbuncles, incision and drainage is necessary, and this is usually adequate for treatment, but antibiotics may be considered in certain cases 1.
Antibiotic Therapy
Antibiotic therapy may be necessary in certain cases, such as:
- Extensive surrounding cellulitis or fever 1.
- Severe or extensive disease, rapid progression, or signs of systemic illness 1.
- Associated comorbidities or immunosuppression, extremes of age, or abscess in an area difficult to drain 1.
Recommended Antibiotics
The following antibiotics may be considered for the treatment of boils:
- Clindamycin 1.
- Trimethoprim-sulfamethoxazole (TMP-SMX) 1.
- Doxycycline or minocycline 1.
- Linezolid 1. It is essential to note that the use of antibiotics should be individualized based on the patient's clinical response and the results of culture tests, if available 1.
From the Research
Definition and Prevalence of Boils
- Boils, also known as furuncles, are globally prevalent bacterial infections involving inflammation of the hair follicle and the perifollicular tissue 2.
- They may progress to cellulitis or lymphadenitis if left untreated 2.
Treatment of Boils
- A systematic review of the best evidence on available treatments for bacterial folliculitis and boils was conducted, including interventions such as topical antibiotics, topical antiseptic agents, systemic antibiotics, phototherapy, and incision and drainage 2.
- The review included 18 randomised controlled trials (RCTs) with 1300 participants, comparing different oral antibiotics, but found no RCTs comparing topical antibiotics against topical antiseptics, topical antibiotics against systemic antibiotics, or phototherapy against sham light 2.
Comparison of Oral Antibiotics
- The review found that there may be little to no difference in clinical cure rate between different oral antibiotics, such as cefadroxil compared to flucloxacillin, azithromycin compared to cefaclor, and cefdinir compared to cefalexin 2.
- However, the certainty of the evidence was often low or very low, and the 95% confidence interval was wide, including the possibility of both increased and reduced risk of events 2.
Adverse Events
- The review found that there may be little to no difference in the risk of severe adverse events leading to treatment withdrawal between different oral antibiotics, but the certainty of the evidence was often low or very low 2.
- Minor adverse events, such as diarrhoea, nausea, and vaginal mycosis, were reported in some studies, but the review found that there is probably little to no difference in the risk of minor adverse events between different oral antibiotics 2.