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Boils — nasty, pus-filled, skin infections around hair follicles — are really annoying. They may resolve spontaneously with the help of hot compresses, or with drainage on your doctor's part, but when do you need to ask for antibiotics for boils?

Today, we are going to be talking about boils or furuncles — nasty, pus-filled, infections around hair follicles generally caused by the bacterium Staphylococcus aureus [1].

Writing about boils is boring, as is reading about boils. I'm pretty sure both you and I would rather be thinking about more interesting medical questions right now, such as fetus in fetu (a twin within a twin), emerging nanotechnology, a Cotard delusion (where a person thinks they are actually dead), or even being born with six toes rather than five. 

If the reason you're reading this right now is that you have a boil yourself, you'll know all too well what else is boring — having boils.

Doctors, apparently, don't always think boils are that exciting, or even important, either. When Trix first went to college, she went through a whole year of constantly being plagued by boils. "They were everywhere; my butt, my legs, even my nose...", Trix said, "and they were very large". The boils would disappear after draining spontaneously after around two weeks, she said, followed by two weeks of peace and then another boil. 

So, what did Trix do? What most people would — she made an appointment with her family doctor to seek help for her recurrent boils, hoping for treatment options that would actually liberate her from her cycle of boils. "Instead, he told me: 'Well, some people have green eyes but want brown eyes'!", Trix recalls. The implication? Boils are simply a fact of life, and she better just deal with them, or not as the case may be. 

If you're currently dealing with a boil, and you've looked for tips about boil medicine or home treatment for boils around the web, we presume that you've come across the following advice:

"Most boils get better without the need for medical treatment. One of the best ways to speed up healing is to apply a warm, moist face cloth to the boil for 10-20 minutes, three or four times a day." [2]

Notes about the role of compresses in improving blood circulation, drawing antibodies to the site of the boil, and helping it come to a head more quickly are usually followed up by notes that the boil may also be drained with the help of a small incision if the boil doesn't clear up on its own after two weeks or so.

While this is absolutely correct, your boil may not fall into the "most boils" category, and this is especially true if you are dealing with recurrent boils. So — when is a boil more than simply annoying? When is it time to ask for boil medicine, and even antibiotics for boils, rather than simply following the usually common-sense instructions to apply compresses, keep the boil clean, prevent re-infecting yourself or infecting others by reusing washcloths and towels that have touched your boil, and avoid squeezing your boil at all costs [3]?

Signs It's Time To Ask For Antibiotics For Boils

The role of antibiotics, such as erythromycin and osteoglycin, in boil treatment was studied as far back as the 1950s — when researchers found that boil patients who received antibiotics recovered sooner and more satisfactorily than those taking placebos [4]. Other studies, however, found that antiobiotic treatment did not influence the outcome of boil treatment, and suggested that drainage only as a way to avoid allergic reactions and side effects in patients as well as a way to save money [5]. This probably led to the minimization of the role of antibiotics in the treatment of boils.

With the emergence of the "super bug" MRSA (Methicillin-resistant Staphylococcus aureus), the role of antibiotics as boil medicine once again became a hot-button issue, however. MRSA boils can be particularly challenging to treat, Data suggest that the role of antibiotics in the treatment of boils is still not quite clear — some studies suggest that drainage only is enough to treat MRSA boils, while others indicate that people with MRSA boils are best off receiving antibiotics alongside boil drainage. [6, 7]

Are you curious what happened to Trix, yet? Trix is among an estimated 10 percent of people who develop recurrent boils after their first brush with these skin abscesses [8]. Since she was clearly unsatisfied with the "hey, you can't change your eye color either" attitude of her first doctor, she asked for a second opinion — and hit the jackpot. Aware that antibiotics sometimes seem to perform as boil medicine, and knowing that Trix had been suffering from repeated boils, this second doctor suggested Trix try Tetracycline. "Somehow, it broke the cycle," Trix said. Though she still has scars, she has been boil-free ever since. 

You, too, may benefit from antibiotics as a boil medicine if:

  • You are dealing with a carbuncle or carbuncles — a cluster of boils that join together underneath the skin. 
  • Your boil is, or your boils are, causing you rather a bit of pain. 
  • You are suffering from a fever as the result of your boils.
  • You have developed cellulitis, a deeper skin infection. 
  • You have a boil or multiple boils on your face. These kinds of boils lead to complications more often. 
  • You are suffering from recurrent boils.
  • More conservative boil treatment does not work for you. [2]

Antibiotics may additionally be prescribed as prophylaxis (preventative treatment) to prevent S. Aureus from infecting other wounds or cuts on your body, and after the medical drainage of a boil [9]. 

If your doctor agrees that it's time for antibiotics for your boil(s), you're most likely to be prescribed:

  • Flucloxacillin
  • Macrolide
  • Tetracycline
  • Mupirocin (a topical preparation)
  • Fusidic acid, a steroid antibiotic [10]

In addition, the disinfectant Chlorhexidine may also be used as boil medicine. 

The Bottom Line

Uncomplicated boils (furuncles) should resolve on their own after about two weeks, or they should resolve after being drained by a doctor. Anyone who suffers from recurring boils or a boil that just won't go away shouldn't have to accept this as a normal, albeit annoying, occurrence. Those people who develop additional symptoms, such as fever, should be especially watchful. Antibiotics can be extremely helpful as a boil medicine for these people. If your doctor doesn't suggest antibiotics as a boil treatment on their own, you, as an informed patient, should feel free to ask about them. 

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