Management of Boils in Children
Introduction to Boil Treatment
- The Infectious Diseases Society of America guidelines recommend that most large furuncles should be treated with incision and drainage, and systemic antimicrobials are usually unnecessary unless fever or other evidence of systemic infection is present 2
- The American Academy of Pediatrics notes that mupirocin is not appropriate for purulent cellulitis or abscesses, and systemic antibiotics should be considered instead, with a strength of evidence based on clinical guidelines 3
Appropriate Management of Boils
- Incision and drainage is the definitive treatment for furuncles and all carbuncles, as recommended by the Infectious Diseases Society of America 2
- Moist heat application may help smaller furuncles rupture and drain spontaneously, with a moderate level of evidence supporting its use 2
- Culture the drainage to identify the causative organism and guide antibiotic selection if needed, as suggested by the Infectious Diseases Society of America 2
When to Add Systemic Antibiotics
- Systemic antibiotics are indicated if the child has fever or systemic signs of infection, markedly impaired host defenses, multiple lesions or surrounding cellulitis, or failed initial drainage attempt, according to the Infectious Diseases Society of America guidelines 1, 2
- The American Academy of Pediatrics recommends considering systemic antibiotics for children with boils who have systemic signs of infection or immunocompromise, with a high strength of evidence supporting this recommendation 1, 2
Antibiotic Selection for Children
- If systemic antibiotics are needed, appropriate oral options include cephalexin 25-50 mg/kg/day divided into 3-4 doses, clindamycin 20-30 mg/kg/day divided into 3 doses, and trimethoprim-sulfamethoxazole 8-12 mg/kg/day based on trimethoprim component in 2 divided doses, as recommended by the Infectious Diseases Society of America 1, 4