Furuncles and Abscesses

Description

General Measures

Medicine Treatment

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

DESCRIPTION

• Localised bacterial skin infection of hair follicles (furuncle/boil) or dermis (abscess), usually with S. aureus.
• The surrounding skin becomes:
  • swollen
  • red
  • hot
  • tender to touch

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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.

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GENERAL MEASURES

Treatment will depend on the abscess size:

• Small furuncles should be managed with a moist, warm compress applied to the 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).

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Note

- Needle aspiration is insufficient for adequate abscess drainage.
- Systemic antibiotics are used only as indicated below

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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, 1 g 8 hourly

LoE:IIIb^v

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

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.0_07 November 2024

Chapter 4 Dermatology_4.4 Furuncles and Abscesses