L02.0-4/L02.8-9/H00.0/H60.0/N76.4/J34.0 + (B95.6)
DESCRIPTION
Localised bacterial skin infection of hair follicles (furuncle/boil) or dermis (abscess), usually with S. aureus.
The surrounding skin becomes:
- swollen,
- red,
- hot , and
- tender to touch.
Note: Boils in diabetic, malnourished or other immunocompromised patients are more likely to develop complications. Check blood glucose levels and HIV status, if the boils are recurrent.
GENERAL MEASURES
Drainage of the abscess is the treatment of choice. Perform surgical incision only if the lesion is fluctuant.
Note: Needle aspiration is insufficient for adequate abscess drainage.
The treatment of choice for small furuncles is moist warm compress to infected area, several times per day to promote drainage.
Large fluctuant lesions should be treated with incision and drainage.
The following sites should be drained by a surgeon:
- Peri-rectal abscess
- Anterior and lateral neck abscess
- Abscess adjacent to nerves or blood vessels e.g carotid artery, facial nerve, central triangle of face (formed by the corners of the mouth and the nasal bridge).
Systemic antibiotics are used only as indicated below.
MEDICINE TREATMENT
Antibiotic therapy
Systemic antibiotics are seldom necessary, except for facial abscesses, or abscesses associated with tender draining lymph nodes, fever, or extensive surrounding cellulitis:
Antibiotics should usually be given for 5–10 days, depending on clinical response.
- Cefazolin, IV, 1g 8 hourly.
When there is clinical improvement, change to:
- Flucloxacillin, oral, 500 mg 6 hourly.
Severe penicillin allergy: (Z88.0)
- Clindamycin, IV, 600 mg 8 hourly.
When there is clinical improvement, change to:
- Clindamycin, oral, 450 mg 8 hourly.