Management of boils and carbuncles

Incision and drainage is the key therapeutic intervention for boils and carbuncles, and achieves cure in approximately 70% of smaller abscesses (diameter 5 cm or less).

Note: Incision and drainage is the key therapeutic intervention for boils and carbuncles.

Data from randomised controlled trials indicate that adjunctive antibiotic therapy provides additional benefit in terms of healing (increasing the rate of cure to approximately 80%) and preventing recurrence, even for small abscessesDaum, 2017Gottlieb, 2019Talan, 2018Talan, Mower, , 2016Wang, 2018. However, these trials investigated antibiotics active against methicillin-resistant Staphylococcus aureus (MRSA) in settings with high MRSA prevalence. The applicability of these data in other settings is uncertain.

Consider adjunctive antibiotic therapy for patients who have a large abscess (eg cavity dimensions greater than 5 cm or extensive surrounding erythema or induration)Daum, 2017Gottlieb, 2019Miller, 2015Talan, 2018Talan, Mower, , 2016Wang, 2018.

For patients who have a smaller abscess, weigh the potential benefits of adjunctive antibiotic therapy against potential harms (eg adverse effects, increased risk of acquiring drug-resistant organisms and Clostridioides difficile [formerly known as Clostridium difficile] infection).

If antibiotic therapy is considered appropriate and there are limited local epidemiological data to guide empirical antibiotic choice, take samples of purulent material from each lesion for microscopy and culture.

The principles of managing boils and carbuncles in people who inject drugs are the same as for any other patient. However, involvement of additional specialities including addiction medicine and psychiatry may be required. Nonjudgemental harm reduction advice may reduce the risk of acquiring serious infections. For printable patient information on harm reduction strategies to minimise risk of infection, see Harm reduction advice to reduce risk of infection for people who inject or smoke drugs. For a more comprehensive patient information sheet on harm reduction advice for people who use substances, see How to get help and reduce harms from alcohol and other drugs or gambling - patient information. For other harm reduction strategies, see Harm reduction in substance use and addictive behaviours.