Infectious Disease Compendium

Furuncles

Diagnosis

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

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 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 vrs 20% of open I&D (PubMed).

For recurrent disease: 2 weeks of po antibiotics PLUS

2 weeks of mupirocin to nose and open lesions PLUS

2 weeks of Hibiclens baths PLUS

hot water/bleach all reused clothes and sheets (wet cottons that you reuse can be a source for recurrent re-inoculation of S. aureus, AND

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?

Pearls

One bid of tmp/sulfa is the dose for a UTI, for a cutaneous S. aureus infection it is probably homeopathic.

Rants

Last Update: 05/27/18.