What is the treatment for multiple boils all over the body?

Treatment for Multiple Boils All Over the Body

For multiple boils (furuncles) distributed across the body, incision and drainage combined with systemic antibiotics is the recommended treatment, as the presence of multiple lesions indicates need for antimicrobial therapy beyond drainage alone. 1

Immediate Management

Surgical Intervention

• Perform incision and drainage on all accessible boils, making an incision over the fluctuant area, thoroughly evacuating pus, and probing the cavity to break up loculations 1, 2
• Cover surgical sites with dry dressings rather than packing with gauze, as simple dressing is usually most effective 1, 2
• For small furuncles that are not yet fluctuant, apply warm moist compresses several times daily to promote spontaneous drainage 1, 3

Antibiotic Therapy

Systemic antibiotics are mandatory when multiple boils are present, as this represents extensive disease requiring antimicrobial coverage 1

First-line oral antibiotic options for outpatient treatment:

• Clindamycin 300-450 mg PO three times daily (adults) or 10-13 mg/kg/dose every 6-8 hours (pediatrics, maximum 40 mg/kg/day) 1, 4
• Trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily (adults) or 4-6 mg/kg trimethoprim component every 12 hours (pediatrics) 1
• Doxycycline 100 mg twice daily (adults, avoid in children <8 years and pregnancy) 1

Duration: 7-10 days for most cases 1

When to Hospitalize

Admit for intravenous antibiotics if any of the following are present: 1

• Systemic toxicity (fever, tachycardia, hypotension)
• Rapidly progressive infection despite oral antibiotics
• Extensive surrounding cellulitis
• Immunocompromised state (diabetes, HIV/AIDS, malignancy)
• Septic phlebitis

Inpatient IV antibiotic options:

• Vancomycin 15-20 mg/kg/dose IV every 8-12 hours (adults) or 15 mg/kg every 6 hours (pediatrics), targeting trough 15-20 mcg/mL 1
• Linezolid 600 mg IV/PO twice daily (adults) or 10 mg/kg every 8 hours (pediatrics, max 600 mg/dose) 1

Decolonization and Prevention of Recurrence

Because multiple boils suggest either recurrent furunculosis or an outbreak situation, decolonization measures are essential: 1

Nasal Decolonization

• Apply mupirocin 2% ointment intranasally twice daily for the first 5 days of each month, which reduces recurrences by approximately 50% 1, 3
• Alternative: Oral clindamycin 150 mg once daily for 3 months (if susceptible S. aureus), which decreases subsequent infections by approximately 80% 1

Hygiene Measures

• Bathe daily with chlorhexidine or antibacterial soap 1, 3
• Launder all clothing, towels, and bed linens thoroughly 1, 3
• Use separate towels and washcloths; do not share with household members 1, 3
• Change and wash clothing daily, especially undergarments and items in contact with affected areas 1

Environmental Considerations

• Evaluate for and address friction from tight clothing, as mechanical stress can trigger boil formation in predisposed individuals 5
• Strongly counsel smoking cessation, as approximately 90% of patients with recurrent boils are smokers, and smoking is a major modifiable risk factor 6, 7

Important Clinical Considerations

Culture and Susceptibility

• Obtain cultures from multiple lesions to guide antibiotic selection, particularly important given rising community-acquired MRSA (CA-MRSA) prevalence 1
• Local resistance patterns should guide empiric therapy; if clindamycin resistance exceeds 10% in your area, choose TMP-SMX or doxycycline instead 1

Risk Factors to Address

Screen for and manage underlying conditions associated with recurrent boils: 6

• Diabetes mellitus (relative risk 1.3 for recurrence)
• Obesity (relative risk 1.3 for recurrence)
• Immunosuppression
• Nasal or perineal S. aureus colonization

Common Pitfalls to Avoid

• Do not rely on antibiotics alone without drainage for fluctuant boils, as cure rates are 85-90% with drainage regardless of antibiotic use 3
• Do not use needle aspiration, which has low success rates and is not recommended 2
• Do not prescribe rifampin as monotherapy, as resistance develops rapidly 1
• Avoid tetracyclines in children under 8 years and pregnant women 1, 4
• Do not confuse with hidradenitis suppurativa, which involves inverse areas (axillae, groin) with chronic recurrent nodules, sinus tracts, and scarring 5

Outbreak Situations

If multiple family members or close contacts are affected, implement outbreak control measures: 1

• All household members should undergo nasal screening for S. aureus colonization 1
• Implement simultaneous decolonization of all colonized individuals 1
• Enhanced environmental cleaning of shared surfaces 1
• Exposure to others with furuncles increases risk more than contact with fomites, so minimize direct contact during active infection 8