Boil, abscess

L02.0-4/L02.8-9/H00.0/H60.0/N76.4/J34.0 + (B95.6)

• Description
• General Measures
• Medicine Treatment
• Referral

DESCRIPTION

Localised bacterial skin infection of hair follicles or dermis, usually with S. aureus .
The surrounding skin becomes:

• swollen
• hot
• red
• tender to touch

Note:

• Check blood glucose level if diabetes suspected or if the boils are recurrent.
  Boils in diabetic or immunocompromised patients require careful management.
• Axillary abscesses and pustules. See Hidradenitis suppurativa

GENERAL MEASURES

• Encourage general hygiene e.g.: frequent showering, keeping nails short.
• Drainage of abscess is the treatment of choice.
• Perform surgical incision only when the lesion is fluctuant.

MEDICINE TREATMENT

Systemic antibiotics are seldom necessary, except if there are:

• Swollen tender lymph nodes in the area
• extensive surrounding cellulitis
• fever
• boils on the face

Antibiotics are also indicated in immunocompromised patients, diabetic patients and neonates:

Children ≤ 7 years of age

• Cefalexin , oral, 12–25 mg/kg/dose 6 hourly for 5 days See paediatric dosing tool.

OR

• Flucloxacillin, oral, 12–25 mg/kg/dose 6 hourly for 5 days. See paediatric dosing tool.

Children > 7 years of age and adults

• Cefalexin , oral, 500 mg 6 hourly for 5 days.

OR

• Flucloxacillin, oral, 500 mg 6 hourly for 5 days.

Severe penicillin allergy: Z88.0

Children:

• Macrolide, e.g.:
• Azithromycin, oral, 10 mg /kg/dose daily for 3 days See paediatric dosing tool.

Adults

• Macrolide, e.g.:
• Azithromycin, oral, 500 mg daily for 3 days.

REFERRAL

• Poor response to treatment.
• Abscesses of the palm of the hand and pulp space abscess of the fingers.
• Features of severe sepsis requiring intravenous antibiotics.
• Deep abscess e.g. ischiorectal and breast abscess.