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Boils, carbuncles, folliculitis, paronychia and staphylococcal whitlow - Management
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Definition
- Folliculitis is superficial infection of the hair follicles which develop into small inflammatory papules or pustules.
For someone with a suspected boil, carbuncle, folliculitis, acute paronychia or staphylococcal whitlow, what assessment do I need to make?
- Size and position of the lesion.
- Presence of pus or fluctuance (wave-like feeling on palpating skin overlying a fluid-filled cavity with nonrigid walls).
- Symptoms suggesting systemic spread of infection.
- Whether a swab is required.
In depth
Do I need to take a swab (boils, carbuncles, folliculitis, paronychia, staphylococcal whitlow)?
- Swabs are not routinely required for initial management.
- Swabs are indicated if the lesion is getting worse over 48 hours despite antibiotic treatment, or there is no response to empirical antibiotic treatment within 5–7 days.
In depth
How should I manage folliculitis?
- Advise people to avoid aggravating factors (e.g. tight clothing or occlusive dressings or plasters, and, if shaving, to shave in the direction of hair growth).
- Daily washing with an antiseptic product may help to prevent or control mild cases.
- For localized folliculitis, topical fusidic acid can be used.
- If folliculitis is more extensive or severe, empirical treatment with oral antibiotics may be needed.
In depth
Which antibiotic should I prescribe (if indicated)? (boils, carbuncles, folliculitis, paronychia, staphylococcal whitlow)
- Oral flucloxacillin is recommended for empirical treatment.
- Oral erythromycin (or clarithromycin if erythromycin is not tolerated) is an alternative for people with penicillin allergy.
In depth
How long should I prescribe antibiotics for? (boils, carbuncles, folliculitis, paronychia, staphylococcal whitlow)
- A 7-day course of empirical antibiotic treatment is recommended.
In depth
How should I manage recurrent or chronic folliculitis?
- Swab the lesion to confirm the causative organism and antibiotic sensitivities.
- Consider whether the cause could be non-infective.
- Consider whether the diagnosis is correct.
- If staphylococcal infection is confirmed, check for carriage of Staphylococcus aureus.
In depth
How should I assess and manage staphylococcal carriage?
Prescriptions
Mild folliculitis: detergent-based antiseptics
Age from 1 year onwards
Hibiscrub 4% solution
Use to wash the affected area once a day. Use either as a soap substitute or added to the bath water.
Supply 250 ml.
Hydrex 4% Surgical Scrub
Use to wash the affected area once a day. Use either as a soap substitute or added to the bath water.
Supply 250 ml.
Aquasept 2% skin cleanser
Use to wash the affected area once a day. Use either as a soap substitute or added to the bath water.
Supply 250 ml.
Ster-Zac Bath Concentrate
Ster-Zac 2% bath concentrate
Add to the bath water and use to wash the affected area once a day.
Supply 500 ml.
Mild folliculitis: antiseptic-emollient products
Age from 1 month onwards
Dermol 200 Shower Emollient
Dermol 200 shower emollient
Use as a soap substitute and wash the affected area(s) once a day.
Supply 200 ml.
Dermol 600 Bath Emollient
Dermol 600 bath emollient
Add to the bath water and use to wash the affected area once a day.
Supply 600 ml.
Emulsiderm bath emollient
Emulsiderm emollient
Add to the bath water and use to wash the affected area once a day.
Supply 300 ml.
Localised folliculitis: topical fusidic acid
Age from 1 month onwards
Fusidic acid 2% cream
Apply a small amount of cream to the affected area three to four times a day.
Supply 15 g.
Severe or extensive folliculitis: flucloxacillin for 7 days
Age from 1 month to 1 year 11 months
Flucloxacillin oral solution: 62.5mg four times a day
Flucloxacillin 125mg/5ml oral solution
Take 2.5ml four times a day for 7 days.
Supply 100 ml.
Flucloxacillin oral solution: 125mg four times a day
Flucloxacillin 125mg/5ml oral solution
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Age from 2 years to 9 years 11 months
Flucloxacillin oral solution: 125mg four times a day
Flucloxacillin 125mg/5ml oral solution
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Flucloxacillin oral solution: 250mg four times a day
Flucloxacillin 250mg/5ml oral solution
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Age from 10 years to 11 years 11 months
Flucloxacillin oral solution: 250mg four times a day
Flucloxacillin 250mg/5ml oral solution
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Flucloxacillin oral solution: 500mg four times a day
Flucloxacillin 250mg/5ml oral solution
Take two 5ml spoonfuls four times a day for 7 days.
Supply 300 ml.
Age from 12 years onwards
Flucloxacillin capsules: 250mg four times a day
Flucloxacillin 250mg capsules
Take one capsule four times a day for 7 days.
Supply 28 capsules.
Flucloxacillin capsules: 500mg four times a day
Flucloxacillin 500mg capsules
Take one capsule four times a day for 7 days.
Supply 28 capsules.
Severe or extensive folliculitis: erythromycin for 7 days
Age from 1 month to 1 year 11 months
Erythromycin s/f suspension: 125mg four times a day
Erythromycin ethyl succinate 125mg/5ml oral suspension sugar free
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Erythromycin s/f suspension: 250mg four times a day
Erythromycin ethyl succinate 250mg/5ml oral suspension sugar free
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Age from 2 years to 11 years 11 months
Erythromycin s/f suspension: 250mg four times a day
Erythromycin ethyl succinate 250mg/5ml oral suspension sugar free
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Erythromycin s/f suspension: 500mg four times a day
Erythromycin ethyl succinate 500mg/5ml oral suspension sugar free
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Age from 12 years onwards
Erythromycin gastro-resistant tablets: 250mg four times a day
Erythromycin 250mg gastro-resistant tablets
Take one tablet four times a day for 7 days.
Supply 28 tablets.
Erythromycin gastro-resistant tablets: 500mg four times a day
Erythromycin 250mg gastro-resistant tablets
Take two tablets four times a day for 7 days.
Supply 56 tablets.
Severe or extensive folliculitis: clarithromycin for 7 days
Age from 1 month to 3 years
Clarithromycin suspension: child weighs 7.9kg or less
Clarithromycin 125mg/5ml oral suspension
*WEIGHT REQUIRED* Take 7.5mg per kg bodyweight TWICE a day for 7 days.
Supply 70 ml.
Age from 3 months to 5 years
Clarithromycin suspension: child weighs 8kg to 11.9 kg
Clarithromycin 125mg/5ml oral suspension
Take 2.5ml twice a day for 7 days.
Supply 70 ml.
Age from 6 months to 7 years
Clarithromycin suspension: child weighs 12kg to 19.9kg
Clarithromycin 125mg/5ml oral suspension
Take one 5ml spoonful twice a day for 7 days.
Supply 70 ml.
Age from 3 to 10 years
Clarithromycin suspension: child weighs 20kg to 29.9kg
Clarithromycin 125mg/5ml oral suspension
Take 7.5ml twice a day for 7 days.
Supply 140 ml.
Age from 7 years to 11 years 11 months
Clarithromycin suspension: child weighs 30kg or more
Clarithromycin 250mg/5ml oral suspension
Take one 5ml spoonful twice a day for 7 days.
Supply 70 ml.
Age from 12 years onwards
Clarithromycin tablets: 250mg twice a day
Clarithromycin 250mg tablets
Take one tablet twice a day for 7 days.
Supply 14 tablets.
Clarithromycin tablets: 500mg twice a day
Clarithromycin 500mg tablets
Take one tablet twice a day for 7 days.
Supply 14 tablets.
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