Treatment of Pediatric Boils with Fever and Decreased Appetite
The recommended treatment for a pediatric patient with a boil accompanied by fever and decreased appetite is incision and drainage of the boil followed by appropriate antibiotic therapy, with careful attention to hydration status and fever management.
Initial Assessment and Management
- Evaluate the severity of illness by assessing the child's overall clinical status, including level of activity, appetite, and fever pattern to determine if the child requires hospitalization or can be managed as an outpatient 1
- Assess for signs of dehydration, as decreased appetite may lead to reduced fluid intake, with particular attention to skin turgor, mucous membranes, capillary refill time, and mental status 1
- Perform careful examination of the boil to determine its size, location, and whether there are signs of surrounding cellulitis or systemic infection 2
Specific Treatment for the Boil
- Incision and drainage (I&D) is the primary treatment for a fluctuant boil, which should be performed regardless of whether antibiotics are prescribed 2
- Obtain cultures from the abscess material during drainage to guide antibiotic therapy, especially important in the setting of systemic symptoms like fever 2
- For small, uncomplicated boils (<5 cm) without systemic symptoms, I&D alone may be sufficient 2
- For larger boils or those with surrounding cellulitis, systemic symptoms (fever), or in immunocompromised patients, antibiotic therapy should be initiated after I&D 2
Antibiotic Selection
- For mild to moderate infections with systemic symptoms like fever, oral antibiotics with MRSA coverage should be considered, such as trimethoprim-sulfamethoxazole, clindamycin, or doxycycline (for children >8 years) 2
- For severe infections or infants <3 months, intravenous antibiotics may be necessary, typically vancomycin or clindamycin until culture results are available 2
- Duration of antibiotic therapy typically ranges from 5-10 days depending on severity and clinical response 2
Management of Fever and Decreased Appetite
- Treat fever primarily for comfort rather than temperature normalization, using appropriate weight-based dosing of antipyretics 3
- Acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) can be used for fever management, with ibuprofen potentially providing longer duration of action 4
- Avoid combining or alternating antipyretics as this may increase risk of dosing errors without significant clinical benefit 5
- Encourage adequate fluid intake to prevent dehydration, especially important in febrile children with decreased appetite 6
- For mild dehydration, administer oral rehydration solution at 50 mL/kg over 2-4 hours; for moderate dehydration, increase to 100 mL/kg over the same period 1, 2
Monitoring and Follow-up
- Patients should be monitored for clinical improvement, including decreased fever, improved appetite, and reduced pain and swelling at the boil site 7
- Follow-up within 24-48 hours is recommended to assess response to treatment 2
- Consider hospitalization if the child shows signs of severe illness, including persistent high fever, significant dehydration, or worsening of the infection despite appropriate outpatient management 1
Special Considerations
- In neonates and young infants (<3 months), boils with fever require more aggressive management, typically hospitalization and intravenous antibiotics 8
- For recurrent boils, consider decolonization strategies and investigation for underlying conditions that may predispose to recurrent skin infections 2
- Educate parents about proper wound care, including keeping the area clean and covered until healed 2
Discharge Criteria (If Hospitalized)
- The child should demonstrate overall clinical improvement, including decreased fever for at least 12-24 hours and improved appetite 7
- Parents should demonstrate understanding of home care instructions, including proper administration of antibiotics and wound care 7
- Ensure follow-up arrangements are in place before discharge 7