Treatment of boils

From HICSIG

Background

Localised skin infection with strains of Staph. aureus, including MRSA may progress to form a pustule or larger collection of pus under the skin (a boil). These infections may follow cuts, scratches or insect bites. They may also occur in hairy areas such as the armpit or around the bottom. Shaving with a razor increases the liklihood of infection because of microabrasions to the skin caused by the razor. Many aggressive strains of Staph. aureus are able to cause boils in people with seemingly normal skin. On occasions the infection may spread to involve the blood stream (septicaemia) with serious consequences.

Local treatment

• bath in salty warm water
• dry with a clean disposable towel (discard with care)
• apply antiseptic cream (eg. iodine ointment, medihoney, savlon or similar)
• consider consulting your GP- incision (a small cut) and drainage is the quickest way to settle the infection. Do not try to do this yourself.
• apply a sterile gauze absorbent dressing (band-aid will do for small boil) that covers the boil well if it is open or has been incised. Change the dressing at least daily or more frequently if it fills with fluid.
• protect the skin in the area of the boil – see skin care routine

If this local approach is not working then see your GP. Do not squeeze the boil or pustule to release the pus- this potentially pushes the infection deeper.

Oral antibiotics

An antibiotic is sometimes prescribed for active boils, however there is no strong evidence that they make a difference to the outcome- more than 8 out of 10 boils will recover with incision, drainage and local dressings. Recent evidence indicates that boils < 5cm in diameter seldom require antibiotic therapy.

Important advice about preventing spread of the infection

• Ensure that you clean your hands well after touching any infected area or applying or handling a wound dressing. The easiest ways are to either hand wash with soap and water or use alcohol hand rub or gel
• Before going to school, pre-school or work, make sure that all open or weeping boils are completely covered with an absorbent dressing and then clean your hands with alcohol gel or rub.

Reference

• Guidelines for UK practice for the diagnosis and management of methicillin-resistant Staphylococcus aureus (MRSA) infections presenting in the community. Nathwani D, Morgan M, Masterton RG, Dryden M, Cookson BD, French G, Lewis D; British Society for Antimicrobial Chemotherapy Working Party on Community-onset MRSA Infections. J Antimicrob Chemother. 2008 May;61(5):976-94 (Pubmed)

Excerpt: 6.1.5 Treatment principles. Recommendation 9A

• Do not give systemic antibiotics to patients with minor skin soft tissue infections or small abscesses (<5 cm). [D3].
• Incise and drain small abscesses without cellulitis and do not give antibiotic therapy. [A1–].
• After incision and drainage start empirical or culture-guided systemic antibiotic therapy for larger abscesses or if there are infections in other family members.