What is the treatment for a deep armpit boil (furuncle)?

From the Guidelines

The primary treatment for a deep armpit boil (furuncle) is incision and drainage, which is likely to be adequate for most simple abscesses, but additional data are needed to further define the role of antibiotics, if any, in this setting. According to the Infectious Diseases Society of America guidelines 1, incision and drainage is the recommended treatment for inflamed epidermoid cysts, carbuncles, abscesses, and large furuncles. The decision to administer antibiotics directed against S. aureus as an adjunct to incision and drainage should be made based upon the presence or absence of systemic inflammatory response syndrome (SIRS).

Some key points to consider in the treatment of deep armpit boils include:

• Applying warm, moist compresses to the area for 10-15 minutes, 3-4 times daily to help bring the boil to a head and promote drainage
• Keeping the area clean by washing gently with antibacterial soap and water
• Avoiding shaving the affected area until healed
• Using over-the-counter medications like acetaminophen (Tylenol, 500-1000mg every 6 hours) or ibuprofen (Advil, 400-600mg every 6-8 hours) for pain relief
• Seeking medical attention if the boil is large, painful, or not improving after a few days, as prescription antibiotics like clindamycin (300-450mg four times daily for 7-10 days) or trimethoprim-sulfamethoxazole (one double-strength tablet twice daily for 7-10 days) may be necessary
• Considering incision and drainage for severe cases, and never attempting to squeeze or lance the boil yourself as this can spread infection.

It's also important to note that recurrent boils may indicate MRSA infection or underlying conditions like diabetes that require additional treatment. The guidelines recommend that an antibiotic active against MRSA is recommended for patients with carbuncles or abscesses who have failed initial antibiotic treatment or have markedly impaired host defenses or in patients with SIRS and hypotension 1.

In terms of specific antibiotic treatments, the guidelines suggest the following options:

• Clindamycin (300-450mg four times daily for 7-10 days)
• Trimethoprim-sulfamethoxazole (one double-strength tablet twice daily for 7-10 days)
• Doxycycline (100mg twice daily)
• Minocycline (200mg three times a day, then 100mg twice daily)
• Linezolid (600mg twice daily)

However, the choice of antibiotic should be based on the severity of the infection, the presence of any underlying conditions, and the results of any culture or sensitivity tests.

From the FDA Drug Label

A small amount of mupirocin ointment should be applied to the affected area three times daily. The area treated may be covered with a gauze dressing if desired. Patients not showing a clinical response within 3 to 5 days should be re-evaluated. The treatment for a deep armpit boil (furuncle) may include applying mupirocin ointment to the affected area three times daily. Key points to consider:

• Apply a small amount of ointment
• Cover the area with a gauze dressing if desired
• Re-evaluate patients if there is no clinical response within 3 to 5 days 2

From the Research

Treatment for Deep Armpit Boil (Furuncle)

• The treatment for a deep armpit boil, also known as a furuncle, typically involves a combination of incision and drainage, as well as antibiotic therapy 3.
• According to a study published in 2021, interventions for bacterial folliculitis and boils, including furuncles, may include topical antibiotics, topical antiseptic agents, systemic antibiotics, phototherapy, and incision and drainage 4.
• The choice of antibiotic may depend on the severity of the infection and the presence of any underlying medical conditions. Cephalexin, a cephalosporin antibiotic, has been shown to be effective in the treatment of streptococcal and staphylococcal skin infections, including furuncles 5.
• A study published in 2022 found that the most common bacteria causing cellulitis and abscesses, including furuncles, are Staphylococcus aureus, Streptococcus pyogenes, and other β-hemolytic streptococci, and that treatment typically involves a penicillin or cephalosporin antibiotic 6.
• In addition to antibiotic therapy, good hygiene practices, such as regular hand washing and avoiding contact with contaminated skin, are essential in preventing the spread of infection and promoting healing 3.

Antibiotic Therapy

• Cephalexin has been shown to be effective in the treatment of streptococcal and staphylococcal skin infections, including furuncles, with cure rates of 90% or higher 5.
• Other antibiotics, such as cefadroxil, azithromycin, and cefaclor, may also be effective in the treatment of furuncles, although the evidence is limited and more research is needed to determine their efficacy 4.
• The choice of antibiotic should be based on the severity of the infection, the presence of any underlying medical conditions, and the results of bacterial culture and sensitivity testing, if available 6.

Incision and Drainage

• Incision and drainage is a common procedure used to treat furuncles, especially those that are large or painful 3.
• Loop drainage is a preferred method of incision and drainage, as it allows for the removal of pus and debris while minimizing tissue damage 6.
• Incision and drainage should be performed by a healthcare professional in a sterile environment to minimize the risk of infection and promote healing 3.