Patient review, and modification and duration of therapy for boils and carbuncles

Modify antibiotic therapy for boils and carbuncles based on clinical response and, if available, results of microbiological testing. If methicillin-resistant Staphylococcus aureus (MRSA) is identified in a patient taking flucloxacillin, dicloxacillin or cefalexin, it may not be necessary to modify therapy if the response to incision and drainage is adequate.

The usual duration of antibiotic therapy is 5 days for patients with boils or carbuncles who have had substantial clinical improvement. Advise patients to return for review after 5 days of therapy if symptoms are not improving; a longer course of up to 10 days may be considered in these patients. These recommendations are based on extensive clinical experience; large clinical trials have demonstrated benefit for antibiotic therapy when continued for 7 or 10 days, but these trials were not designed to investigate the duration of therapyDaum, 2017Talan, Lovecchio, , 2016Talan, Mower, , 2016.

If symptoms worsen, an earlier clinical review is recommended, including collection of purulent material for microscopy and culture, if not previously obtained.