From the FDA Drug Label
DOSAGE AND ADMINISTRATION The penicillinase-resistant penicillins are available for oral administration and for intramuscular and intravenous injection. Bacteriologic studies to determine the causative organisms and their sensitivity to the penicillinase-resistant penicillins should always be performed.
The best initial antibiotic for treating folliculitis is not explicitly stated in the provided drug labels. However, based on the information provided, dicloxacillin can be considered for the treatment of skin and soft tissue infections caused by susceptible strains of staphylococci, which are commonly associated with folliculitis.
- The dosage of dicloxacillin for mild to moderate infections is 125 mg every 6 hours for adults, and 12.5 mg/kg/day in equally divided doses every 6 hours for children weighing less than 40 kg (88 lbs.) 1. It is essential to note that bacteriologic studies should be performed to determine the causative organisms and their susceptibility to the chosen antibiotic.
- Clindamycin is also indicated for the treatment of serious skin and soft tissue infections caused by susceptible strains of staphylococci, but its use should be reserved for penicillin-allergic patients or other patients for whom a penicillin is inappropriate 2.
From the Research
The best initial antibiotic for treating folliculitis is typically topical mupirocin (Bactroban) 2% ointment applied to affected areas three times daily for 7-10 days. For mild to moderate cases, this topical approach is often sufficient to clear the infection. If the folliculitis is more extensive or severe, oral antibiotics that cover Staphylococcus aureus (the most common causative organism) are recommended, such as cephalexin 500 mg four times daily for 7-10 days or dicloxacillin 500 mg four times daily for 7-10 days. According to a recent study 3, comparative trials have not identified important differences in efficacy or safety outcomes between different oral antibiotics for treating bacterial folliculitis or boils. However, for patients with suspected MRSA or penicillin allergy, alternatives include trimethoprim-sulfamethoxazole DS twice daily or doxycycline 100 mg twice daily, as suggested by another study 4. These antibiotics work by targeting the bacterial cell wall or protein synthesis, effectively eliminating the infection. While treating folliculitis, patients should also practice good hygiene, avoid sharing personal items, use antibacterial soap, and avoid tight clothing to prevent recurrence and spread of infection. Warm compresses applied to the affected area for 15-20 minutes several times daily can help drain pustules and speed healing. It's also worth noting that a study from 2015 5 found that oral isotretinoin was the most successful oral treatment for folliculitis decalvans, with 90% of patients experiencing stable remission during and up to two years after cessation of treatment. However, this may not be applicable to all types of folliculitis, and more research is needed to confirm its effectiveness. In general, the choice of antibiotic should be guided by the severity of the infection, the presence of any underlying medical conditions, and the patient's allergy history, as well as the most recent and highest quality evidence available 3.
Some key points to consider when treating folliculitis include:
- The importance of practicing good hygiene and avoiding sharing personal items to prevent the spread of infection
- The use of antibacterial soap and avoiding tight clothing to reduce the risk of recurrence
- The application of warm compresses to the affected area to help drain pustules and speed healing
- The potential need for oral antibiotics in more severe cases, and the importance of choosing an antibiotic that covers Staphylococcus aureus
- The consideration of alternative treatments, such as oral isotretinoin, in certain cases.
Overall, the treatment of folliculitis should be guided by the most recent and highest quality evidence available, and should take into account the individual patient's needs and circumstances.