From the Guidelines
The management of recurrent furuncles (boils) should prioritize incision and drainage, as well as a search for local causes such as pilonidal cyst, hidradenitis suppurativa, or foreign material, and consideration of a decolonization regimen for recurrent S. aureus infection 1.
Immediate Treatment
For immediate treatment, warm compresses should be applied to the boil several times daily for 10-15 minutes to promote drainage. Once the boil comes to a head, it may need incision and drainage by a healthcare provider.
Antibiotic Treatment
For recurrent boils, a 5- to 10-day course of an antibiotic active against the pathogen isolated should be considered, as recommended by the Infectious Diseases Society of America 1.
Decolonization Regimen
A decolonization regimen, including a 5-day course of intranasal mupirocin, daily chlorhexidine washes, and daily decontamination of personal items, may be recommended for recurrent S. aureus infection 1.
Prevention of Recurrence
To prevent recurrence, daily cleansing with antibacterial soap, keeping the skin dry, and avoiding sharing personal items are essential. Underlying conditions like diabetes or immune disorders should be addressed, as they can contribute to recurrent infections.
Key Considerations
- Recurrent abscesses should be drained and cultured early in the course of infection 1.
- Adult patients should be evaluated for neutrophil disorders if recurrent abscesses began in early childhood 1.
- The major method of controlling recurrent furunculosis is the use of antibacterial agents to eradicate staphylococcal carriage 1.
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 management for recurrent furuncles (boils) is not directly addressed in the provided drug label for mupirocin ointment. However, for the treatment of boils, topical antibiotics like mupirocin may be used.
- Apply a small amount of mupirocin ointment to the affected area three times daily.
- The affected area may be covered with a gauze dressing if desired.
- If there is no clinical response within 3 to 5 days, the patient should be re-evaluated 2
From the Research
Management of Recurrent Furuncles (Boils)
The management of recurrent furuncles (boils) involves several steps, including:
- Incision and drainage of the abscess or furuncle, as this is the standard of care 3, 4
- Culture of the exudate to identify the causative organism, particularly in recurrent cases 3, 5
- Use of oral antibiotics, such as cephalexin or dicloxacillin, in cases where the infection is severe or the patient has a weakened immune system 3, 6
- Consideration of methicillin-resistant Staphylococcus aureus (MRSA) coverage in patients with infections that have not improved with treatment 3, 7
- Potential use of tetracyclines, such as doxycycline or minocycline, as an oral treatment option for patients with community-onset MRSA skin and soft tissue infections 7
Prevention of Recurrent Infections
Prevention of recurrent infections is also important, and may involve:
- Providing patients and families with instructions on how to prevent future infections, such as proper wound care and hygiene 5
- Considering the use of decolonization techniques, such as nasal swabbing and bathing with antimicrobial soap, to reduce the risk of recurrent infections 5
- Educating patients and families on the importance of completing the full course of antibiotics and following up with healthcare providers to ensure that the infection has been fully treated 5