Treatment for Furuncles
The primary recommended treatment for furuncles is incision and drainage, with antibiotics generally unnecessary for uncomplicated cases that have been adequately drained. 1
Primary Treatment Approach
Incision and Drainage
- Incision and drainage is the cornerstone of furuncle management and should be performed when the lesion becomes fluctuant 1
- After drainage, simply cover the surgical site with a dry dressing
- Avoid packing the wound with gauze as this causes more pain without improving healing 1
When to Add Antibiotics
Antibiotics should be added in the following circumstances:
- Presence of systemic inflammatory response syndrome (SIRS) with:
- Temperature >38°C or <36°C
- Tachypnea >24 breaths per minute
- Tachycardia >90 beats per minute
- White blood cell count >12,000 or <400 cells/µL 1
- Facial furuncles (due to risk of serious complications like cavernous sinus thrombosis) 1, 2
- Multiple lesions or carbuncles
- Immunocompromised patients
- Patients with poorly controlled diabetes or other comorbidities 1
Antibiotic Selection
When antibiotics are indicated, the following options are recommended:
First-line Options
- Clindamycin: 300-450 mg orally three times daily for 5-10 days 1, 3
- Effective against S. aureus (including MRSA) and streptococci
- Pediatric dosing: 8-16 mg/kg/day divided into three or four equal doses 3
Alternative Options
- Dicloxacillin: 250 mg every 6 hours (for mild to moderate infections) or 500 mg every 6 hours (for severe infections) 4
- Best absorbed when taken on an empty stomach (1 hour before or 2 hours after meals)
- Pediatric dosing: 12.5-25 mg/kg/day in equally divided doses every 6 hours 4
- Trimethoprim-sulfamethoxazole (TMP-SMX): 1-2 double-strength tablets twice daily 1
- Doxycycline: 100 mg twice daily (not recommended for children under 8 years) 1
Special Considerations
- In areas with high prevalence of community-acquired MRSA, empirical coverage should include clindamycin, TMP-SMX, or doxycycline 1
- Duration of antibiotic therapy is typically 5-10 days, adjusted according to clinical response 1
- For severe staphylococcal infections, therapy should continue for at least 14 days 4
Management of Recurrent Furunculosis
Recurrent furunculosis requires additional measures:
Identify and address underlying causes:
Decolonization measures:
Hygiene improvements:
Family screening:
- Culture swabs from family members and close contacts to identify carriers 5
- Implement decolonization for all carriers to break the chain of infection
Common Pitfalls to Avoid
- Overuse of antibiotics for uncomplicated furuncles that have been adequately drained 1
- Inadequate drainage leading to incomplete evacuation of pus 1
- Needle aspiration for carbuncles (low success rate <25% overall, <10% with MRSA) 1
- Failure to identify carriers among family members or close contacts, leading to reinfection cycles 1
- Overlooking hygiene measures and simply treating with antibiotics without addressing underlying hygiene issues 1, 5
- Delayed treatment of facial furuncles, which can lead to serious complications 1, 2
- Failure to investigate underlying causes or predisposing conditions 1
Special Populations
Diabetic Patients
- More susceptible to skin infections due to impaired immune function and poor circulation
- Should seek immediate medical care if infection is accompanied by fever, severe pain, rapid spread, or if they have poorly controlled diabetes 1