What is the treatment for an infected furuncle (boil)?

From the Guidelines

The treatment for an infected furuncle (boil) typically involves warm compresses, proper wound care, and sometimes antibiotics, with incision and drainage being the primary treatment for large or severe cases, as recommended by the Infectious Diseases Society of America 1.

Treatment Approach

The approach to treating an infected furuncle involves several key steps:

• Apply warm, moist compresses to the boil for 10-15 minutes, 3-4 times daily to help bring the infection to a head and promote drainage.
• Keep the area clean by washing gently with antibacterial soap and water.
• Do not squeeze or lance the boil yourself as this can spread the infection.
• If the boil is large, severely painful, or not improving after a few days of home treatment, medical intervention may be necessary, which may include incision and drainage under sterile conditions, as suggested by the guidelines 1.

Antibiotic Use

For infected furuncles, oral antibiotics may be prescribed, but their use is generally reserved for cases with signs of systemic infection or when incision and drainage are not sufficient, as indicated by the guidelines 1. The choice of antibiotic may depend on the suspected causative organism, with options including:

• Dicloxacillin 500 mg four times daily
• Cephalexin 500 mg four times daily
• Clindamycin 300 mg four times daily for 7-10 days
• If MRSA is suspected, trimethoprim-sulfamethoxazole (Bactrim) or doxycycline may be used instead, as recommended by the guidelines 1.

Prevention of Complications

Proper treatment of infected furuncles is crucial to prevent complications such as cellulitis or the spread of infection to other body areas, highlighting the importance of prompt and appropriate management, as emphasized by the guidelines 1.

From the FDA Drug Label

The cure rates in microbiologically evaluable patients with MRSA skin and skin structure infection were 26/33 (79%) for linezolid-treated patients and 24/33 (73%) for vancomycin-treated patients The cure rates by pathogen for microbiologically evaluable patients are presented in Table 18. Table 18 Cure Rates at the Test-of-Cure Visit for Microbiologically Evaluable Adult Patients with Complicated Skin and Skin Structure Infections Pathogen Cured ZYVOX n/N (%) Oxacillin/Dicloxacillin n/N (%) Staphylococcus aureus 73/83 (88) 72/84 (86) Methicillin-resistant S aureus 2/3 (67) 0/0 (-) Streptococcus agalactiae 6/6 (100) 3/6 (50) Streptococcus pyogenes 18/26 (69) 21/28 (75)

The treatment for an infected furuncle (boil) may include linezolid or vancomycin.

• Linezolid is effective against MRSA and other Gram-positive pathogens, with cure rates of 79% in microbiologically evaluable patients with MRSA skin and skin structure infection 2.
• Vancomycin is also effective against MRSA, with cure rates of 73% in microbiologically evaluable patients with MRSA skin and skin structure infection 2.
• Clindamycin may be used to treat serious infections, including those caused by anaerobic bacteria, with dosages ranging from 150 to 450 mg every 6 hours for adults 3. It is essential to consult a healthcare professional to determine the best course of treatment for an infected furuncle.

From the Research

Treatment Options for Infected Furuncle (Boil)

• A simple furuncle can be treated by incision and drainage 4
• Systemic antibiotics are indicated in only special circumstances, and Gram stain is helpful in choosing an appropriate one 4
• For uncomplicated community-acquired MRSA (CA-MRSA) skin and soft-tissue infections, minocycline is reliably effective 5
• Doxycycline or trimethoprim-sulfamethoxazole with incision/drainage should be used as initial therapy for SSTI when MRSA is suspected 6

Antibiotic Selection

• Cefadroxil, flucloxacillin, azithromycin, cefaclor, cefdinir, and cefalexin are some of the antibiotics that have been compared in terms of clinical cure rate and risk of adverse events 7
• There may be little to no difference in clinical cure rate between cefdinir and cefalexin, and between cefditoren pivoxil and cefaclor 7
• Trimethoprim-sulfamethoxazole, cephalexin, and clindamycin are commonly prescribed antibiotics for empiric outpatient therapy of cellulitis, with trimethoprim-sulfamethoxazole having a higher treatment success rate than cephalexin 8

Considerations for Treatment

• The choice of antibiotic should be based on the suspected or confirmed causative organism and its antibiotic sensitivity profile 4, 6, 8
• Incision and drainage is an important part of the treatment for furuncles and boils 4, 5, 6
• Future trials should incorporate culture and sensitivity information and consider comparing topical antibiotic with antiseptic, and topical versus systemic antibiotics or phototherapy 7