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Boils, carbuncles, folliculitis, paronychia and staphylococcal whitlow - Management
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Who should I swab for staphylococcal carriage (boils, carbuncles, folliculitis, paronychia, staphylococcal whitlow)?
- Consider taking swabs for carriage of Staphylococcus aureus in people with recurrent or chronic boils, carbuncles, or folliculitis.
- Swabbing for carriage of Staphylococcus aureus in recurrent cases of paronychia or staphylococcal whitlow can be considered, but if the person requires referral, this may be done in secondary care as part of their further management.
In depth
Where should I swab for carriage of staphylococcus aureus (boils, carbuncles, folliculitis, paronychia, staphylococcal whitlow)?
- In primary care, nasal swabs should be taken.
In depth
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 to:
- Use an antiseptic preparation to reduce staphylococcal skin colonization. Washing the skin (preferably including hair), and daily bathing is recommended in an antiseptic solution of chlorhexidine or triclosan in a detergent vehicle.
- 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.
In depth
Which antiseptic solution should I use?
- A solution of chlorhexidine or triclosan in a detergent vehicle is generally suitable:
- Hibiscrub® and Hydrex® Surgical Scrub contain chlorhexidine.
- Aquasept® skin cleanser and Ster-Zac bath concentrate® contain triclosan.
- For dry or inflamed skin, or application to the face, use an antiseptic emollient:
- The Dermol® range contains chlorhexidine and benzalkonium chloride.
- Emulsiderm® bath additive contains benzalkonium chloride.
Prescriptions
Eradication of nasal staphylococcal carriage
Age from 1 month onwards
1st choice: mupirocin 2% nasal ointment
Mupirocin 2% nasal ointment
Apply a small amount of ointment to the inside of each nostril three times a day for 5 days.
Supply 3 g.
Treatment failure: Naseptin nasal cream
Naseptin nasal cream
Apply a small amount of cream to the inside of each nostril four times a day for 10 days.
Supply 15 g.
Eradication of non-nasal staphylococcal carriage
Age from 1 month onwards
Advice only: non-nasal staphylococcal carriage
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.
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.
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