Infectious Disease Compendium

Furuncles

Diagnosis

Big painful boils. There is a histologic difference between a carbuncle and a furuncle and I do not care. A ball of pus is a ball of pus.

Epidemiologic Risks

Scratching when colonized with S. aureus.

Microbiology

S. aureus.

Empiric Therapy

I&D, plus oral antibiotics. Given that most are MRSA trimethoprim/sulfamethoxazole 2-3 ds po tid or doxycycline are the only reliable and affordable oral agents; let local susceptibilities by your guide.

I&D may be all you need. Antibiotics probably do more to prevent recurrence than hasten resolution.

For MRSA boils, I&D plus trimethoprim/sulfamethoxazole was equal to I&D plus placebo for the cure of acute disease, although the antibiotic group had less recurrence (PubMed).

And do not just suck out the pus with a needle, compared to an I&D, 74% of needle aspiration FAILED vs 20% of open I&D (PubMed).

For recurrent disease (PubMed): 2 weeks of po antibiotics PLUS

  • 2 weeks of mupirocin to the nose and open lesions PLUS
  • 2 weeks of Hibiclens baths (I suggest the whole family including the dog and/or cat at least once) PLUS
  • Hot water/bleach all reused clothes and sheets (wet cotton that you reuse can be a source for recurrent re-inoculation of S. aureus. PLUS
  • No scratching after picking your nose usually aborts recurrent disease. For women (and some men) new make-up. New razor blades. Flip the mattress and new pillows. It is usually not necessary to treat family members or pets, although who could argue with tossing the cat in the washer/dryer?

Rants

With the exception of Peter Parker, it is NOT NOT NOT from a spider bite (PubMed)(PubMed).;

Last Update: 06/22/18.