From the Guidelines
Furuncles can be effectively treated with moist heat to promote drainage, and larger ones may require incision and drainage, with systemic antimicrobials usually unnecessary unless fever or other evidence of systemic infection is present. When treating furuncles, it is essential to keep the area clean by washing gently with antibacterial soap and water. Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help manage pain and inflammation. Some key points to consider when treating furuncles include:
- Applying warm compresses to the affected area for 10-15 minutes, 3-4 times daily to help bring the infection to a head and promote drainage 1
- Avoiding squeezing or lancing the boil yourself, as this can spread infection
- Seeking immediate medical attention if the furuncle is accompanied by fever, severe pain, multiple lesions, or occurs on the face or spine
- Considering incision and drainage by a healthcare provider for larger or more painful furuncles, and possibly oral antibiotics such as cephalexin (Keflex) 500mg four times daily, clindamycin 300mg four times daily, or trimethoprim-sulfamethoxazole (Bactrim) DS twice daily for 7-10 days 1 It is also important to note that furuncles are caused by Staphylococcus aureus bacteria infecting a hair follicle, creating a painful, pus-filled bump, and proper treatment helps prevent complications and recurrence. According to the most recent guidelines, moist heat and incision and drainage are the primary treatments for furuncles, with systemic antibiotics reserved for cases with evidence of systemic infection 1.
From the FDA Drug Label
Adults: Serious infections – 150 to 300 mg every 6 hours. More severe infections – 300 to 450 mg every 6 hours Serious infections due to anaerobic bacteria are usually treated with CLEOCIN PHOSPHATE® Sterile Solution. However, in clinically appropriate circumstances, the physician may elect to initiate treatment or continue treatment with clindamycin hydrochloride capsules.
Furuncle treatment with clindamycin (PO) may involve dosing for serious infections, which is 150 to 300 mg every 6 hours, or for more severe infections, which is 300 to 450 mg every 6 hours 2.
- The treatment should be determined by the physician based on the severity of the infection and the causative bacteria.
- Anaerobic bacterial infections are usually treated with a different formulation, but clindamycin hydrochloride capsules may be used in certain circumstances.
From the Research
Furuncle Treatment
- Furuncles, also known as boils, are bacterial infections involving inflammation of the hair follicle and the perifollicular tissue 3.
- The primary causative organism of furuncles is Staphylococcus aureus, with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) being a common cause of furuncles 4.
- Treatment of furuncles depends on the severity of the infection and the susceptibility of the causative organism to antibiotics.
Antibiotic Treatment
- For methicillin-susceptible S. aureus (MSSA) infections, penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) are the antibiotics of choice 5.
- For methicillin-resistant S. aureus (MRSA) infections, parenteral vancomycin or teicoplanin are recommended 5.
- For less serious MRSA infections, lincosamides (clindamycin, lincomycin) or cotrimoxazole may be used 5.
- A systematic review of randomized controlled trials found that different oral antibiotics (e.g. cefadroxil, flucloxacillin, azithromycin, cefaclor) may have similar efficacy in treating bacterial folliculitis or boils, but the certainty of the evidence is often low or very low 3.
Other Treatment Options
- Incision and drainage may be necessary for large or complicated furuncles 3.
- Phototherapy and topical antiseptics may also be used to treat furuncles, but there is limited evidence on their efficacy compared to other treatments 3.
- Nasal carriage of S. aureus is a primary risk factor for recurrent furunculosis, and treatment of nasal carriage may be necessary to prevent recurrence 4.