Boil medical therapy: Difference between revisions

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Latest revision as of 20:39, 29 July 2020

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.

Medical therapy^[1]^[2]

Mild

Preferred regimen: incision and drainage

Moderate

Empiric treatment :TMP-SMX OR Doxycycline
Culture directed treatment

MSSA (methicilin susceptible staphylococcus aureus): TMP-SMX
MRSA (methicilin resistant staphylococcus aureus): Dicloxacillin OR Cephalexin

Severe

Empiric treatment :Vancomycin OR Daptomycin OR Linezolid OR Televancin OR Ceftaroline
Culture directed treatment

MSSA (methicilin susceptible staphylococcus aureus): Nafcillin OR Cefazolin OR Clindamycin
MRSA (methicilin resistant staphylococcus aureus): Vancomycin OR Daptomycin OR Linezolid OR Televancin OR Ceftaroline

References

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

Template:WikiDoc Sources

[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

[1]

[2]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Boil}}
-{{CMG}}
+{{CMG}}; {{AE}}{{YK}}
 ==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==
-===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==
 {{Reflist|2}}
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