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Boils, carbuncles, folliculitis, paronychia and staphylococcal whitlow - Management
How should I manage non-fluctuant boils and carbuncles?

  • Advise the person to apply moist heat three to four times a day.
  • Offer antibiotics if:
    • There is also fever or cellulitis.
    • The lesion is large (e.g. carbuncle) or on the face.
    • There are other comorbidities (e.g. diabetes).
  • Offer analgesia (paracetamol or ibuprofen) if needed.
  • Consider admission if the person is unwell, or the infection is in an area where complications can be serious (e.g. the face).
Clarification / Additional information
  • The decision of whether to admit the person will depend on clinical judgement, taking into account the rapidity and degree of spread, and whether or not the person (or carer) is able to follow instructions reliably regarding monitoring of complications.
Basis for recommendation
  • These recommendations are pragmatic advice, based on the most likely causative organism (Staphylococcus aureus) and expert opinion from the medical literature [Lee et al, 2003; Ladhani and Garbash, 2005; Stevens et al, 2005].
  • The aim of applying moist heat is to relieve discomfort, help localize the infection, and promote drainage.
  • It is uncertain whether antibiotics should be used to treat all boils, as CKS could find no trial evidence. Expert opinion suggests that antibiotics are not always necessary, but should be particularly considered if the lesion is large (e.g. carbuncles) or there is associated fever or surrounding cellulitis, there are other comorbidities (e.g. diabetes), or the site means complications are more likely (e.g. cavernous sinus thrombosis can result from boils on the face). For more information, see Complications.
  • Most cases can be treated in primary care provided the person is closely monitored for signs of systemic upset.

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