Boil, Abscess

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Click here to access the Primary-Healthcare-Chapter-5-Skin-Conditions-with-Supporting-NEMLC-Report-2020-4-Review-Version-2.0-November-2025

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Description

General Measures

Medicine Treatment

Referral

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ICD 10 code: L02.0-4/L02.8-9/H00.0/H60.0/N76.4/J34.0 + (B95.6)

DESCRIPTION

• Localised bacterial skin infection of hair follicles or dermis, usually with S. aureus
• The surrounding skin becomes:
  • Swollen 
  • Hot
  • Red
  • Tender to touch

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Note:
- Check blood glucose level if diabetes suspected or if the boils are recurrent. Boils in diabetic or immunocompromised patients require careful management
- For axillary abscesses and pustules, see: Hidradenitis suppurativa

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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, unless the following features are present:

• 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

• Cephalexin, oral, 25 mg/kg/dose 12 hourly for 5 days. See: dosing table

OR

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

Children > 7 years of age and adults

• Cephalexin, oral, 500 mg 6 hourly for 5 days

OR

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

For severe penicillin allergy: 
ICD 10 code: Z88.0

Children

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

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

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024

Chapter 5: Skin Conditions_5.4.1 Boil, Abscess