From the Guidelines
Furunculosis, a skin condition characterized by recurrent boils or furuncles, should be treated with incision and drainage for large or extremely painful boils, while mild cases may be managed with warm compresses and topical antibiotics like mupirocin 2% ointment. The diagnosis of furunculosis involves identifying painful, pus-filled bumps that form under the skin due to Staphylococcus aureus bacterial infection of hair follicles.
Treatment Options
- For mild cases, topical antibiotics like mupirocin 2% ointment applied three times daily for 7-10 days may be sufficient 1.
- More severe or recurrent cases require oral antibiotics such as cephalexin (500mg four times daily), dicloxacillin (500mg four times daily), or trimethoprim-sulfamethoxazole (one double-strength tablet twice daily) for 7-10 days.
- Large or extremely painful boils may need incision and drainage by a healthcare provider 1.
- To prevent recurrence, patients should practice good hygiene including daily showers with antibacterial soap, avoid sharing personal items, change clothes and towels daily, and wash bedding regularly in hot water.
Decolonization Therapy
- For those with recurrent furunculosis, decolonization therapy may be recommended, which includes using chlorhexidine wash or bleach baths and intranasal mupirocin for 5-7 days 1.
- The condition occurs when bacteria enter through breaks in the skin and is more common in people with diabetes, compromised immune systems, or those in close contact with infected individuals.
Key Considerations
- Incision and drainage is the primary treatment for simple abscesses or boils, and antibiotics are not needed 1.
- 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 1.
From the Research
Diagnosis of Furunculosis
- The diagnosis of furunculosis involves a thorough medical history, clinical examination, and specific microbiological and biochemical investigations 2.
- Culture swabs from the patient, family members, and close contacts are mandatory to identify and ultimately control the chain of infection 2, 3.
- Gram stain is helpful in choosing an appropriate antibiotic 4.
Treatment of Furunculosis
- Solitary lesions should be incised when fluctuant, whereas patients with multiple lesions or signs of systemic disease or immunosuppression should be treated with relevant antibiotics 2.
- The CMC regimen, which includes skin disinfection with chlorhexidine, local nasal antibiotic (mupirocin), and systemic antibiotic (clindamycin), has been shown to be effective in treating recurrent furunculosis 3.
- Low-dose clindamycin or a macrolide for 3 months may be prescribed as an oral antibiotic, in addition to the use of an antimicrobial nasal ointment and soap, and hygienic instructions 5.
- Fusidic acid ointment may be used for prevention of relapses, and patients and healthy family members who carry the patient strain may apply the ointment in nares twice daily every 4th week 6.
Prevention of Recurrent Furunculosis
- Focus on personal, interpersonal, and environmental hygiene issues is crucial to reduce the risk of contamination and recurrences 2.
- Eradication of Staphylococcus aureus should be considered in recurrent cases, and screening swabs from all sites should be taken to identify carriers 3.
- Treatment of close contacts who are carriers of the infection is also important in preventing recurrences 3.