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Boils, carbuncles, folliculitis, paronychia and staphylococcal whitlow - Management
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Definition
- Staphylococcal whitlow is an abscess of the fleshy area of the palmar aspect of the fingertip.
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 do I manage staphylococcal whitlow without fluctuance?
- Advise the person to:
- Elevate the finger.
- Use warm soaks three to four times a day.
- 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 (e.g. osteomyelitis, skin necrosis, sinus tract formation, septic joint, tenosynovitis, compartment syndrome) are suspected.
- Offer analgesia (paracetamol or ibuprofen) if needed.
In depth
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 (e.g. osteomyelitis, skin necrosis, sinus tract formation, septic joint, tenosynovitis, compartment syndrome) are suspected.
- Offer analgesia (paracetamol or ibuprofen) if 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
What should I do if there is no response to treatment (staphylococcal whitlow)?
- Urgently discuss further management with a specialist, for example general-, plastic-, or orthopaedic surgeon, depending on local policy.
In depth
Prescriptions
1st-line antibiotic: 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.
1st-line in penicillin allergy: 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.
!st-line in penicillin allergy: 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.
Analgesia: use when required
Age from 1 month to 2 months
Paracetamol s/f susp: 30mg to 60mg up to three times a day
Paracetamol 120mg/5ml oral suspension paediatric sugar free
Take 1.25ml to 2.5ml every 8 hours when required for pain relief. Maximum of 3 doses in 24 hours.
Supply 100 ml.
Ibuprofen s/f susp: 5mg/kg three to four times a day (> 5kg)
Ibuprofen 100mg/5ml oral suspension sugar free
*WEIGHT REQUIRED* Take 5mg per kg bodyweight three to four times a day when required for relief of pain. Do not exceed the stated dose.
Supply 50 ml.
Age from 3 to 5 months
Ibuprofen s/f susp: 50mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take 2.5ml three times a day when required for pain relief. Do not exceed the stated dose.
Supply 50 ml.
Age from 3 to 11 months
Paracetamol s/f susp: 60mg to 120mg up to four times a day
Paracetamol 120mg/5ml oral suspension paediatric sugar free
Take 2.5ml to 5ml every 4 to 6 hours when required for pain relief. Maximum of 4 doses in 24 hours.
Supply 150 ml.
Age from 6 to 11 months
Ibuprofen s/f susp: 50mg three to four times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take 2.5ml three to four times a day when required for pain relief. Do not exceed the stated dose.
Supply 100 ml.
Age from 1 year to 3 years 11 months
Ibuprofen s/f susp: 100mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take one 5ml spoonful three times a day when required for pain relief. Do not exceed the stated dose.
Supply 100 ml.
Age from 1 year to 5 years 11 months
Paracetamol s/f susp: 120mg to 240mg up to four times a day
Paracetamol 120mg/5ml oral suspension paediatric sugar free
Take one to two 5ml spoonfuls every 4 to 6 hours when required for pain relief. Maximum of 4 doses in 24 hours.
Supply 300 ml.
Age from 4 years to 6 years 11 months
Ibuprofen s/f susp: 150mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take 7.5ml three times a day when required for pain relief. Do not exceed the stated dose.
Supply 150 ml.
Age from 6 years to 11 years 11 months
Paracetamol s/f susp: 250mg to 500mg up to four times a day
Paracetamol 250mg/5ml oral suspension sugar free
Take one to two 5ml spoonfuls every 4 to 6 hours when required for pain relief. Maximum of 4 doses in 24 hours.
Supply 300 ml.
Age from 7 years to 9 years 11 months
Ibuprofen s/f susp: 200mg up to three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take two 5ml spoonfuls three times a day when required for pain relief. Do not exceed the stated dose.
Supply 200 ml.
Age from 10 years to 11 years 11 months
Ibuprofen s/f susp: 300mg up to three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take three 5ml spoonfuls three times a day when required for pain relief. Do not exceed the stated dose.
Supply 300 ml.
Age from 12 years to 17 years 11 months
Paracetamol tablets: 500mg to 1g up to four times a day
Paracetamol 500mg tablets
Take one or two tablets every 4 to 6 hours when required for pain relief. Maximum of 8 tablets in 24 hours.
Supply 50 tablets.
Ibuprofen tablets: 200mg to 400mg three to four times a day
Ibuprofen 200mg tablets
Take one or two tablets 3 to 4 times a day when required for pain relief. Do not exceed the stated dose.
Supply 56 tablets.
Age from 18 years onwards
Paracetamol tablets: 1g up to four times a day
Paracetamol 500mg tablets
Take two tablets every 4 to 6 hours when required for pain relief. Maximum of 8 tablets in 24 hours.
Supply 50 tablets.
Ibuprofen tablets: 400mg three times a day
Ibuprofen 400mg tablets
Take one tablet three times a day when required for pain relief. Do not exceed the stated dose.
Supply 21 tablets.
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