Treatment of Folliculitis with Bactrim and Nystatin Powder: Patient Education
Bactrim (Trimethoprim-Sulfamethoxazole) for Folliculitis
For bacterial folliculitis, particularly when caused by Staphylococcus aureus including MRSA, take Bactrim DS (double-strength: 160 mg trimethoprim/800 mg sulfamethoxazole) one tablet by mouth twice daily for 7-10 days. 1
Key Dosing Instructions for Bactrim
- Take exactly twice daily (morning and evening), approximately 12 hours apart 1
- Complete the entire course even if symptoms improve rapidly within 2-3 days 1
- Can be taken with or without food, though taking with food may reduce stomach upset 2, 3
- Drink plenty of fluids while taking this medication to prevent kidney complications 3
Expected Response Timeline
- You should see improvement within 48-72 hours of starting treatment 1
- If no improvement occurs by 72 hours, contact your healthcare provider as this may indicate antibiotic resistance or need for drainage if an abscess has formed 1
Important Side Effects to Monitor
Common side effects include:
Serious reactions requiring immediate medical attention:
- Severe skin reactions (blistering, peeling) - Stevens-Johnson syndrome 1
- Difficulty breathing or swallowing 1
- Severe diarrhea 3
- Unusual bleeding or bruising 4
Critical Contraindications
- Do not take if you are in the third trimester of pregnancy 4
- Inform your provider if you have kidney disease, as dose adjustment may be needed 3
- Avoid if you have known sulfa allergy 1
Nystatin Powder for Concurrent Fungal Prevention
When Nystatin Powder is Used
Nystatin powder may be prescribed alongside Bactrim when there is concern for secondary fungal (yeast) infection in skin folds or areas prone to moisture, particularly if folliculitis is in intertriginous areas 5
Application Instructions
- Apply topically to clean, dry affected areas 5
- Typically applied 2-4 times daily to the affected skin folds 5
- Continue application for the full prescribed duration, usually 7-14 days 5
- Nystatin powder is less effective than azole antifungals for most fungal infections, but useful for keeping areas dry 5
Important Notes About Nystatin
- Nystatin works only against yeast/fungal organisms, not bacteria 5
- It is poorly absorbed through skin, making systemic side effects rare 5
- Keep the treated area as dry as possible between applications 5
- If using in groin or other skin folds, ensure complete drying after bathing before application 5
General Folliculitis Care Instructions
Hygiene Measures
- Wash affected areas gently with antibacterial soap daily 6
- Avoid shaving or waxing the affected area until completely healed 6
- Do not squeeze, pick, or pop follicular pustules as this can worsen infection and cause scarring 6
- Change towels, washcloths, and clothing daily to prevent reinfection 6
Follow-Up Care
- Return for evaluation if symptoms worsen or do not improve within 72 hours 1
- Complete follow-up appointment even if symptoms resolve to ensure complete clearance 6
- Some patients remain clear for months to years after appropriate antibiotic treatment 6
When to Seek Immediate Care
- Fever over 100.4°F (38°C) 1
- Rapidly spreading redness or warmth 1
- Increasing pain or swelling 1
- Development of large, painful boils or abscesses 1
Alternative Treatment Options
If Bactrim is not tolerated or contraindicated, alternative antibiotics include: