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Boils, carbuncles, folliculitis, paronychia and staphylococcal whitlow - Management
How do I manage staphylococcal whitlow with fluctuance?
- Refer for incision and drainage:
- Only attempt in primary care if skilled in incising and draining staphylococcal whitlows.
- In addition, treat empirically with oral antibiotics.
- Referral for IV antibiotics should be considered if oral antibiotics fail, the person is unwell, or proximal lymphangitis or cellulitis is present.
- Urgently discuss management with a specialist if complications are suspected.
- Offer analgesia (paracetamol or ibuprofen) if needed.
Basis for recommendation
- These recommendations are pragmatic advice, based on the most likely causative organism (Staphylococcus aureus) and expert opinion from the medical literature [Clark, 2003; Lee et al, 2003].
- There is the potential for serious complications (e.g. osteomyelitis) to develop as a result of staphylococcal whitlow [Lee et al, 2003; Rontal and Bailey, 2005; Vaughn, 2006].
- Serious complications can also occur as a result of inappropriate drainage techniques for staphylococcal whitlow. Incision and drainage can be done locally, but only if the skills to do this exist within the practice.
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