Download Recurrent Staphylococcus aureus boils

Recurrent Staphylococcus aureus boils
Staphylococcus aureus (Staph) has been a problem germ for all of recorded history. More
recently, there are some resistant strains that cause boils and other infections; they may
be hard to eliminate. Here are some hints about what may help.
Treating boils
Most boils are superficial, and need only topical treatment. Warm soaks 3 to 5 times day
can help the body respond and clear the infection. Don’t poke or squeeze the boil; it will
drain eventually on its own in most cases. When there is drainage, this drainage contains
large number of organisms and should be captured in a sterile gauze to prevent high
concentration spread to other areas. Whenever these boils are touched or handled, there
should be careful hand washing related to that.
If there is fever or increasing pain, you may need to have the boil cut open by a doctor to
let them drain. Don’t try this at home; the result may only complicate the matter.
Antibiotics are used if there is evidence of spread beyond the local area or if the pain is
very deep. Staph has become resistant to our common antibiotics, so we sometimes have
to use other antibiotics to clear the infection. Clindamycin, Bactrim (cotrimoxazole), and
moxifloxacin (Avelox) may be helpful if cephalexin (Keflex) fails.
Prevention
Staph likes moist places; keeping clean and dry is helpful. Using an antimicrobial liquid
soap can help. For adults, I frequently recommend a soap containing 2% chlorhexidine
gluconate (CHG). A standard antimicrobial soap is probably adequate.
Careful hand hygiene is essential; wash your hands with soap and water. Alcohol based
hand gels are also effective.
There are hiding places for Staph elsewhere in the house; I’d pay particular attention to
the bathroom. I would use only fresh wash cloths with each bath or shower. I encouraged
showers instead of baths. A soap containing an anti-microbial may be helpful, like Dial
with an anti-microbial. I’ve encouraged them to move from bar soap to a pump of liquid
soap with an anti-microbial since that will not be contaminated by sitting in a tray for a long
period of time. This may help reduce the superficial number of organisms to reduce the
chance of inoculation and subsequent boils. The germ may be harbored in moist materials
in the bathroom, like wash clothes and towels. Use washcloths once and then laundering
them, and let towels completely dry.
Antibiotic therapy is not effective in getting rid of Staph aureus from the nares or rectum, or
from the environment. Sometimes we use special topical antibiotic ointment in the nose
(mupirocin, Bactroban™). If the germ is being passed around in the family, the whole
family may need to be treated at the same time.
Decontamination of the environment is often impractical because of the extensive
involvement. Using simple soap and water, and allowing things to dry well, is probably all
that is required for Staphylococcus aureus. Careful hand hygiene should be practiced.
I suggest using these measures for at least the next 6 to12 months.
In general, the sores will decrease with time as your body works up immunity.
Call your doctor if there is any evidence of fever greater than 100.5oF. In addition, they
should look at the size of the pimple. If it is under 1cm (a dime size) lesion, this can be
treated with topical warmth only. Once the lesion is greater than an inch (a quarter size) it
is reasonable to seek medical attention to look at the area. Certainly when there is a large
amount of surrounding cellulitis in addition to the boil, I find it of some benefit to use a
short course of antibiotics. In these cases using clindamycin 300mg every 6 hours is
appropriate. Usually Bactrim DS twice a day is also effective. Additionally, for adults we
can use moxifloxacin 400mg daily or levofloxacin 500mg twice daily if the germ is
sensitive. Fluctuance should be treated with professional incision and drainage. Warm
soaks should be done 3-5x a day for 10-20 minutes.
Instructions written by Dr. Mark Shelly, MD, Infectious Disease Specialist, Highland
Hospital. © 2007, 2008