What are Boils?
These skin infections are caused by a bacteria called Staphylococcus aureus. The bacteria infect a hair follicle resulting in the formation of a small swelling that goes on to form an abscess. The abscess usually drains out resulting in resolution of the furuncle. In some cases, however, the infection can spread through the skin and even to other parts of the body.
Though boils can affect anybody, it occurs more often in people with reduced immunity like diabetes patients or patients on corticosteroid.
A warm compress applied to the boil may help it heal. Some furuncles may require surgical draining.
Local antibiotics: Local antibiotics like fusidic acid and retapamulin can be used to treat furunculosis. These are usually not associated with any major side effects.
Oral antibiotics are necessary when the patient has multiple furuncles with fever or reduced immunity. Oral drugs used to treat furunculosis include:
- Penicillins: Penicillins are a group of commonly used antibiotics used in the treatment of furunculosis. Ampicillin is a commonly used penicillin used for skin infections. Unfortunately, the bacteria very often produce an enzyme called penicillinase that destroys penicillin. To prevent this, another drug clavulanic acid is given in the same formulation as ampicillin. Clavulanic acid inhibits the enzyme penicillinase produced by the bacteria and allows the ampicillin to act.
- Penicillinase-resistant penicillins like dicloxacillin: Another option to treat resistant infections is with the use of penicillin antibiotics that cannot be destroyed by penicillinase. These include drugs like dicloxacillin and Oxacillin.
- Cephalosporins: Cephalexin is a commonly used cephalosporin used in the treatment of furunculosis. It is a drug related to penicillin.
- Erythromycin or clindamycin: The most common problem associated with penicillin is the chance of developing an allergic reaction. The allergic reaction can vary from a simple rash to a life-threatening situation. In such situation, it is necessary to use an antibiotic that is not a penicillin or in any way related to penicillin like cephalosporin. Therefore, drugs like erythromycin or clindamycin are used in these cases.
- Drugs to treat methicillin-resistant Staphylococcus aureus. Some strains of Staphylococcus aureus called methicillin-resistant Staphylococcus aureus (MRSA) are highly resistant to penicillins and are treated with drugs from other groups. These drugs include:
- Trimethoprim-sulfamethoxazole which is actually a combination of two drugs given together for better effect.
- Minocycline or doxycycline, which belongs to the tetracycline group of antibiotics. These antibiotics should not be administered in pregnancy.
- Very serious infections are treated in a hospital with intravenous drugs like vancomycin or linezolid.
Staphylococcus aureus bacteria often remain on the skin and in the nostrils without causing infection. These could be the sources of recurrent furunculosis and should therefore be eliminated. Treatment of nasal carriers is done by using the following drugs:
- Mupirocin cream or fusidic acid ointment for 5 days of each month. These are applied to the nasal mucosa to eliminate the bacteria causing boils and thereby prevent recurrences. Mupirocin is a local antibiotic that is effective even against methicillin-resistant Staphylococcus aureus
- Oral rifampicin for 10 days. Rifampicin is actually a drug that is used for the treatment of tuberculosis. Although it is effective against a wide range of bacteria, its use in all these infections is avoided to reduce the chances of developing resistance. However, it can be used in the treatment of nasal carriers of Staphylococcus aureus.
- Beside the nostrils, Staphylococcus aureus can also be found on the skin. Therefore, it is necessary to keep the skin clean with a good antibacterial soap especially if you tend to suffer from repeated infections.
- Get yourself checked for diabetes, anemia etc. to rule out any predisposing factor.
- Other family members should take extra hygiene methods to keep the skin clean.
- Do not share clothes and handkerchiefs. Skin and underclothes should be kept clean.
- Use the antibiotic for the prescribed number of days. A short duration or a too-long duration could lead to ineffectiveness.
- Harrison’s Principles of Internal Medicine 19th edition.
- Katzung BG, Masters SB, Trevor AJ. Basic and Clinical Pharmacology 12th edition.
- Weller R, Hunter H, Mann MW. Clinical Dermatology.