Boil medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.

For recurring cases, sufferers may benefit from diet supplements of Vitamin A and E.

In serious cases, prescription oral antibiotics 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 super bug known as Community-Associated Methicillin-Resistant Staphylococcus Aureus, or 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

• If fever, carbuncles, recurrences -> systemic abx vs. S. aureus

• Dicloxacillin 500 mg po q6h x 10-14 days

• Alternatives:

• Cephalexin 250 mg qid
• Clindamycin 150 mg qid
• Bactrim

• Abx

• Mupirocin 2% ointment to anterior nares bid x 5 days

• Eliminates S. aureus nasal carriage for up to 90 days
• Also effective against MRSA, but 40% recur on maintenance Rx

• Rifampin 600 mg po qd x 10 days

• Eliminates nasal carriage for up to 3 months
• Consider in patients who have failed other preventive measures
• Rx acute recurrence simultaneously w/dicloxacillin or alternative x 10d

• Clindamycin 150 mg po qd x 3 months (suppressive regimen)

• Shown in one study to decrease frequency of recurrence