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Boils, carbuncles, folliculitis, paronychia and staphylococcal whitlow - Management
How should I treat staphylococcal carriage (boils, carbuncles, folliculitis, paronychia and staphylococcal whitlow)?

  • Eliminate nasal carriage: apply mupirocin nasal ointment three times a day for 5 days.
    • Following treatment, three clear swabs over a 3 week period are required to confirm eradication.
    • If mupirocin is not effective (e.g. in mupirocin-resistant isolates), consider applying Naseptin® cream (chlorhexidine plus neomycin) four times a day for 10 days.
    • If both mupirocin and Naseptin® are ineffective, seek expert advice regarding the need for throat-carriage screening and the need for systemic antibiotics.
  • Eliminate non-nasal carriage: oral treatment with antibiotics may be necessary, especially if there is throat carriage. The choice of antibiotic should be guided by sensitivities. Advice may be sought from the local infection control team.
  • In addition, advise the person to:
    • Use an antiseptic preparation to reduce staphylococcal skin colonization. Washing the skin (preferably including hair), and daily bathing in an antiseptic solution of chlorhexidine or triclosan in a detergent vehicle, is recommended. For further information on which antiseptic preparation to use, see Which antiseptic product to prescribe.
    • Wash sheets and underwear regularly on a hot wash cycle (above 55°C). The clothes should be turned inside out and the machine not overloaded so that the water can circulate.
    • Thoroughly clean the bedroom at the same time as treatment is started.
    • Use his or her own towel and flannel, and rinse the flannel in hot water before use.
  • Dressings should be changed frequently if purulent discharge collects.
  • If boils, carbuncles, or folliculitis persist after screening and treating the person, seek advice from the local infection control team.
Basis for recommendation

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