What is the treatment for a furuncle (boil)?

Treatment of Furuncles (Boils)

The primary treatment for furuncles is incision and drainage for large furuncles, while small furuncles may be effectively managed with moist heat application alone to promote spontaneous drainage. 1

Initial Management

• For small furuncles, apply moist heat to promote drainage, which is often sufficient treatment 2, 1
• For larger furuncles and all carbuncles, perform incision and drainage as the definitive treatment 2, 1
• After drainage, cover the surgical site with a dry dressing rather than packing with gauze 1

Antibiotic Therapy

• Systemic antibiotics are usually unnecessary unless specific conditions are present: 2, 1

  • Extensive surrounding cellulitis
  • Fever or other evidence of systemic infection
  • Multiple lesions
  • Immunocompromised host
  • Systemic inflammatory response syndrome (SIRS)

• When antibiotics are indicated, options include: 2

  • For outpatient treatment of MRSA-suspected infections:
    • Trimethoprim-sulfamethoxazole
    • Doxycycline or minocycline (not for children <8 years)
    • Clindamycin (if local resistance rates are low)
  • For more severe infections requiring hospitalization:
    • Vancomycin IV
    • Linezolid 600 mg PO/IV twice daily
    • Daptomycin 4 mg/kg/dose IV once daily
    • Telavancin 10 mg/kg/dose IV once daily
    • Clindamycin 600 mg IV/PO three times daily

Management of Recurrent Furunculosis

• For patients with recurrent furunculosis, consider decolonization strategies: 1, 3

  • Apply mupirocin 2% ointment to the anterior nares twice daily for 5 days each month (reduces recurrences by ~50%) 2, 4
  • For more persistent cases, consider low-dose clindamycin 150 mg daily for 3 months (reduces subsequent infections by ~80%) 2, 5
  • Daily chlorhexidine washes can help reduce recurrences 1, 5

• Additional measures for recurrent cases: 2, 6

  • Screen and treat household members who may be carriers
  • Improve personal hygiene with antibacterial soaps
  • Thoroughly launder clothing, towels, and bedding in hot water
  • Use separate towels and washcloths
  • Evaluate for underlying conditions that may predispose to recurrence

Special Considerations

• In areas with high MRSA prevalence, empiric antibiotic choices should cover MRSA if antibiotics are deemed necessary 2, 6
• For pediatric patients with minor skin infections, mupirocin 2% topical ointment can be used 2
• Tetracyclines should not be used in children under 8 years of age 2
• For patients not showing clinical response within 3-5 days of treatment, reevaluation is necessary 4

Pitfalls and Caveats

• Failure to drain adequately is the most common reason for poor response to treatment 1
• Facial furuncles require special attention due to risk of serious complications including cavernous sinus thrombosis 7
• Do not attempt to squeeze or manually rupture furuncles, as this can spread infection 6
• The CMC regimen (chlorhexidine skin disinfection, mupirocin nasal application, and clindamycin oral therapy) has shown 87% remission beyond 9 months in recurrent cases 5