From the Guidelines
To treat a boil, incision and drainage is the primary treatment, and antibiotics may be recommended in certain cases, such as severe or extensive disease, systemic illness, or lack of response to incision and drainage alone, as suggested by the Infectious Diseases Society of America guidelines 1. The treatment of boils, also known as furuncles, typically involves applying warm compresses to the affected area for 10-15 minutes, 3-4 times daily to help bring the boil to a head and promote drainage. It is essential to keep the area clean by washing gently with antibacterial soap and water, then covering with a sterile bandage. Patients should avoid squeezing or lancing the boil themselves, as this can spread infection. Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help manage pain and inflammation. Some key points to consider in the treatment of boils include:
- Incision and drainage is the recommended treatment for large furuncles, carbuncles, abscesses, and inflamed epidermoid cysts 1.
- The decision to administer antibiotics directed against S. aureus as an adjunct to incision and drainage should be made based on the presence or absence of systemic inflammatory response syndrome (SIRS) 1.
- An antibiotic active against MRSA is recommended for patients with carbuncles or abscesses who have markedly impaired host defenses and in patients with SIRS 1.
- Gram stain and culture of pus from carbuncles and abscesses are recommended, but treatment without these studies is reasonable in typical cases 1. If the boil is large, extremely painful, doesn't improve within 2 weeks, recurs frequently, or is accompanied by fever or red streaks extending from the area, patients should seek medical attention. A healthcare provider may need to drain the boil professionally and prescribe antibiotics such as cephalexin (Keflex) 500mg four times daily for 7-10 days or clindamycin 300mg four times daily for those with penicillin allergies. Boils are caused by bacterial infections, usually Staphylococcus aureus, that infect a hair follicle or oil gland, creating a painful, pus-filled bump that the body is trying to fight off through the inflammatory response.
From the Research
Boil Treatment
- Boils are a type of skin and soft tissue infection that can be caused by methicillin-resistant Staphylococcus aureus (MRSA) 2, 3.
- The treatment of boils depends on the severity of the infection and the presence of any underlying medical conditions 4.
- For less serious boils, oral antibiotics such as clindamycin, doxycycline, and trimethoprim-sulfamethoxazole may be effective 5, 2, 6.
- For more severe boils, intravenous antibiotics such as vancomycin or teicoplanin may be necessary 5, 4.
- Debridement and drainage of the boil may also be necessary to help clear the infection 4, 2.
- It is essential to monitor the response to treatment and adjust the antibiotic regimen as needed to ensure the infection is fully cleared 4, 3.
Antibiotic Options
- Clindamycin is a commonly used antibiotic for the treatment of skin and soft tissue infections, including boils caused by MRSA 5, 4, 2.
- Doxycycline and trimethoprim-sulfamethoxazole are also effective against MRSA and may be used as alternative treatments 2, 6.
- Vancomycin and teicoplanin are typically reserved for more severe infections or those that are resistant to other antibiotics 5, 4.
- Linezolid and quinupristin/dalfopristin are newer antibiotics that may be effective against MRSA, but are typically reserved for patients who have failed other treatments or have highly resistant strains of the bacteria 5.