Boil medical therapy: Difference between revisions

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==Overview==
==Overview==
Most boils run their course within 4 to 10 days. For most people, self-care by applying a warm compress or soaking the boil in warm water can help alleviate the pain and hasten draining of the pus (colloquially referred to as "bringing the boil to a head"). Once the boil drains, the area should be washed with antibacterial soap and bandaged well.
The mainstay of therapy for mild furuncles is [[incision and drainage]] only. [[Antimicrobial]] therapies are indicated in moderate and severe furuncles. Empiric [[antimicrobial]] therapies for furuncle include either [[TMP-SMX]] or [[Doxycycline]] for moderate furuncles, and either [[Vancomycin]], [[Daptomycin]], [[Linezolid]], [[Telavancin]], or [[Ceftaroline]] for severe furuncles.
 
For recurring cases, sufferers may benefit from diet supplements of [[Vitamin A]] and [[Vitamin E|E]].
 
In serious cases, prescription oral [[antibiotic]]s such as [[dicloxacillin]] (Dynapen) or [[cephalexin]] (Keflex), or topical antibiotics, are commonly used. For patients allergic to penicillin-based drugs, [[erythromycin]] (E-base, Erycin) may also be used.
 
However, some boils are caused by a [[Antibiotic resistance|super bug]] known as '''Community-Associated Methicillin-Resistant ''Staphylococcus Aureus''''', or '''[[MRSA|CA-MRSA]]'''. [[Bactrim]] or other [[sulfa]] drugs must be prescribed relatively soon after boil has started to form. [[MRSA]] tends to increase the speed of growth of the infection.
 
[[Magnesium sulfate]] paste applied to the affected area can prevent the growth of bacteria and reduce boils by absorbing pus and drying up the lesion.


==Medical Therapy==
==Medical Therapy==
===Pharmacotherapy ===
===Boil (furuncle)===
:*If [[fever]], [[carbuncle]]s, recurrences -> systemic abx vs. [[S. aureus]]
*Spontaneous healing:
::*[[Dicloxacillin]] 500 mg po q6h x 10-14 days
:*After a period of itching and mild pain, the boils (furuncles) may heal spontaneously.
:*Alternatives: 
*Medical therapy<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref><ref>Boils(furuncle).MedlinePlus(2016).https://medlineplus.gov/ency/article/001474.htm Accesses on August 11,2016</ref>
::*[[Cephalexin]] 250 mg qid
:* '''Mild'''
::*[[Clindamycin]] 150 mg qid
::* Preferred regimen: [[incision and drainage]]
::*[[Bactrim]]
:* '''Moderate'''
:*Abx
::* Empiric treatment :[[TMP-SMX]] {{or}} [[Doxycycline]]
::*[[Mupirocin]] 2% ointment to anterior nares bid x 5 days
::* '''Culture directed treatment'''
:::*Eliminates [[S. aureus]] nasal carriage for up to 90 days
:::* MSSA (methicilin susceptible staphylococcus aureus): [[TMP-SMX]]
:::*Also effective against [[MRSA]], but 40% recur on maintenance Rx
:::* MRSA (methicilin resistant staphylococcus aureus): [[Dicloxacillin]] {{or}} [[Cephalexin]]
::*[[Rifampin]] 600 mg po qd x 10 days
:* '''Severe'''
:::*Eliminates nasal carriage for up to 3 months
::* Empiric treatment :[[Vancomycin]] {{or}} [[Daptomycin]] {{or}} [[Linezolid]] {{or}} [[Televancin]] {{or}} [[Ceftaroline]]
:::*Consider in patients who have failed other preventive measures
::* Culture directed treatment
:::*Rx acute recurrence simultaneously w/[[dicloxacillin]] or alternative x 10d
:::* MSSA (methicilin susceptible staphylococcus aureus): [[Nafcillin]] {{or}} [[Cefazolin]] {{or}} [[Clindamycin]]
::*[[Clindamycin]] 150 mg po qd x 3 months (suppressive regimen)
:::* MRSA (methicilin resistant staphylococcus aureus): [[Vancomycin]] {{or}} [[Daptomycin]] {{or}} [[Linezolid]] {{or}} [[Televancin]] {{or}} [[Ceftaroline]]
:::*Shown in one study to decrease frequency of recurrence


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Up-To-Date]]
[[Category:Dermatology]]
[[Category:Emergency medicine]]
[[Category:Infectious disease]]

Latest revision as of 20:39, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Overview

The mainstay of therapy for mild furuncles is incision and drainage only. Antimicrobial therapies are indicated in moderate and severe furuncles. Empiric antimicrobial therapies for furuncle include either TMP-SMX or Doxycycline for moderate furuncles, and either Vancomycin, Daptomycin, Linezolid, Telavancin, or Ceftaroline for severe furuncles.

Medical Therapy

Boil (furuncle)

  • Spontaneous healing:
  • After a period of itching and mild pain, the boils (furuncles) may heal spontaneously.
  • Mild
  • Moderate
  • Severe

References

  1. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  2. Boils(furuncle).MedlinePlus(2016).https://medlineplus.gov/ency/article/001474.htm Accesses on August 11,2016


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