# Bacterial Folliculitis - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - antimicrobial-2023.pdf, Flucloxacillin monograph (chapter PDF p361) · Winters RD, Mitchell M. Folliculitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK547754. PMID: 31613534. · Egyptian Drug Authority - National Guidance of Rational Antimicrobial Use in the Management of Skin and Soft Tissue Infection, EDREX:GU.CAP.Care.015 version 1, 11/2025 · Egyptian National Drug Formulary - Antimicrobial 2023, mupirocin monograph · Egyptian National Drug Formulary - Antimicrobial 2023, cephalexin monograph · Egyptian National Drug Formulary - Antimicrobial 2023 (sulfamethoxazole and trimethoprim monograph) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - antimicrobial-2023.pdf, Flucloxacillin monograph (chapter PDF p361) - Egyptian Drug Authority - National Guidance of Rational Antimicrobial Use in the Management of Skin and Soft Tissue Infection, EDREX:GU.CAP.Care.015 version 1, 11/2025 - Egyptian National Drug Formulary - Antimicrobial 2023, mupirocin monograph - Egyptian National Drug Formulary - Antimicrobial 2023, cephalexin monograph ## Treatment metadata - Mupirocin — topical - Flucloxacillin — oral.solid - Cefalexin — 500 mg — oral.solid - Sulphamethoxazole + Trimethoprim — oral.solid ## Complete treatment card ```text BACTERIAL FOLLICULITIS Sources: Egyptian National Drug Formulary - antimicrobial-2023.pdf, Flucloxacillin monograph (chapter PDF p361) · Winters RD, Mitchell M. Folliculitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK547754. PMID: 31613534. · Egyptian Drug Authority - National Guidance of Rational Antimicrobial Use in the Management of Skin and Soft Tissue Infection, EDREX:GU.CAP.Care.015 version 1, 11/2025 · Egyptian National Drug Formulary - Antimicrobial 2023, mupirocin monograph · Egyptian National Drug Formulary - Antimicrobial 2023, cephalexin monograph · Egyptian National Drug Formulary - Antimicrobial 2023 (sulfamethoxazole and trimethoprim monograph) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Increased scratching from itching, often with heavy sweating [itching · sweating] - History of topical steroid use or recent/long-term oral antibiotics - Recent hot tub or swimming pool exposure - HIV with a CD4 count under 250, or other immunosuppression, raises risk SIGNS - what you find (1) - Small pustules with surrounding perifollicular inflammation in hair-bearing skin [pustules] TESTS (3) - Diagnosis is clinical; testing is generally not needed - KOH prep can show the hyphae and spores of Malassezia folliculitis - A skin biopsy is usually needed to confirm eosinophilic folliculitis IF NOT THIS - what else fits (5) - Papulopustular rosacea: facial redness and pustules rather than a hair-follicle infection - Folliculitis triggered by a medication rather than infection - Hidradenitis suppurativa: recurrent nodules and abscesses in skin folds - Pseudofolliculitis barbae from ingrown shaved hairs - Acne keloidalis nuchae, scarring bumps at the nape of the neck Source StatPearls "Folliculitis" - disease-level clinical article Status traced to the source above Rx: Topical antibiotic - first line | Oral antibiotic - extensive or deeper disease | Oral antibiotic - gram-negative folliculitis TOPICAL ANTIBIOTIC - FIRST LINE 1. MUPIROCIN [1st line] Adult Apply 2% ointment to the affected area three times daily x 7 to 14 days, with review at 3 to 5 days if there is no response Peds A small amount three times daily for 5 to 10 days, with review at 5 days if there is no clinical response (Egyptian National Drug Formulary, mupirocin monograph). A topical dose is not weight-based. Source Egyptian Drug Authority - National Guidance of Rational Antimicrobial Use in the Management of Skin and Soft Tissue Infection, EDREX:GU.CAP.Care.015 version 1, 11/2025 for the indication - verbatim, the folliculitis row of its treatment table: "Folliculitis: Topical antibiotics (e.g., mupirocin, retapamulin)." Dose from the same document's dosing appendix - verbatim: "Mupirocin: 2% ointment applied 3 times per day." Duration from Egyptian National Drug Formulary - Antimicrobial 2023, mupirocin monograph - verbatim: "Apply to affected area 2 to 3 times daily, typically for 7 to 14 days depending on severity and clinical response; if no response after 3 to 5 days, re- evaluate treatment." Why The treatment Egypt's own national guidance gives for folliculitis, and the one the international article names first for disease extensive enough to treat at all. Most simple staphylococcal folliculitis settles on its own within a few days. Caution Most simple folliculitis needs no antibiotic. The source expects a few pustules to resolve spontaneously within a few days, and reserves topical treatment for more extensive disease. A painful nodule with a central pustule is a boil, not folliculitis, and a coalesced mass draining from several follicles is a carbuncle. Both are drainage decisions before they are antibiotic ones. Re-evaluate rather than extend if there is no response after 3 to 5 days. Egypt BACTROFORM 2% TOP. OINT. 15 GM WESTERN PHARM... 35.00 EGP MUPIROCIN SAJA 2% TOP. OINT. 15 GM BIOPHARM EGYPT > SAJA PHARMA 35.00 EGP MUPIRAX 2% OINT. 10 GM GLOBAL NAPI P... 48.00 EGP MUPIROCIN SAJA 2% TOP. OINT. 20 GM BIOPHARM EGYPT > SAJA PHARMA 83.00 EGP MUPIRAX 2% OINT. 30 GM GLOBAL NAPI P... 118.00 EGP ORAL ANTIBIOTIC - EXTENSIVE OR DEEPER DISEASE - choose one 2. FLUCLOXACILLIN [2nd line] Adult 250 mg orally (or by intramuscular injection) four times daily; the dose may be doubled for a severe infection. - As directed (formulary gives no fixed course length for this dose; a short course, e.g. 5-7 days, is typical clinical practice for more extensive or recurrent disease). Peds Age-banded rather than weight-based by mouth: 1 month to 1 year 62.5 to 125 mg, 2 to 9 years 125 to 250 mg, 10 years and older 250 to 500 mg, all four times daily (Egyptian National Drug Formulary, flucloxacillin monograph, quoting BNFC for beta-lactamase- producing staphylococcal infection including impetigo and cellulitis). Cefalexin carries a weight-based dose if one is preferred. Source Egyptian National Drug Formulary - antimicrobial-2023.pdf, Flucloxacillin monograph (chapter PDF p361) Why Bacterial folliculitis is usually a staphylococcal skin/soft-tissue infection, matching flucloxacillin's formulary indication; an oral course is used for more extensive or recurrent disease beyond what a topical antibiotic would cover. Caution No plain flucloxacillin is sold in Egypt. All 33 live products are combinations with amoxicillin or ampicillin, so the patient goes home with a second antibiotic as well - check the pack and account for it. Penicillin allergy is a contraindication - ask about prior reactions before prescribing. Spreading redness, fever, or a large fluctuant area suggests an abscess or cellulitis needing drainage or reassessment rather than oral antibiotics alone. Recurrent folliculitis in a diabetic or immunosuppressed patient needs closer follow-up and consideration of predisposing factors. Rare but serious cholestatic jaundice/hepatitis can occur, more often with longer courses and in older patients. Egypt FLUMOCIN 250MG 12CAPS. UP PHARMA 6.20 EGP (0.52/unit) -> ! also contains amoxicillin AMOFLUX 125/125MG 12 CAPS. RAMEDA > DELT... 8.25 EGP (0.69/unit) -> ! also contains amoxicillin FLUCAMOX 250MG 12CAPS. SEDICO 8.25 EGP (0.69/unit) -> ! also contains amoxicillin FLUMOCIN 500MG 8 CAPS. UP PHARMA 6.00 EGP (0.75/unit) -> ! also contains amoxicillin CURAFLUX 125/125 MG 12 CAPS. RAMEDA > PIONEER 12.50 EGP (1.04/unit) -> ! also contains amoxicillin AMOFLUX 250/250MG 16 CAPS. RAMEDA > PIONEER 18.00 EGP (1.12/unit) -> ! also contains amoxicillin HI-FLUCIL 250/250MG 16 CAPS. CID 20.00 EGP (1.25/unit) -> ! also contains amoxicillin AMPIFLUX 500 MG 12 CAPS. PHARCO 16.00 EGP (1.33/unit) -> ! also contains ampicillin 3. CEFALEXIN [2nd line] Adult 500 mg orally every 6 hours - The formulary states no course length for skin infection - review at 5 to 7 days rather than repeating a prescription Peds 25-50 mg/kg/day [child max 2000 mg] (25 to 50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day (Egyptian National Drug Formulary, cephalexin monograph, general dosing for mild to moderate infection).) 3kg -> 75-150 mg/day 4kg -> 100-200 mg/day 5kg -> 125-250 mg/day 6kg -> 150-300 mg/day 7kg -> 175-350 mg/day 8kg -> 200-400 mg/day 9kg -> 225-450 mg/day 10kg -> 250-500 mg/day 11kg -> 275-550 mg/day 12kg -> 300-600 mg/day 13kg -> 325-650 mg/day 14kg -> 350-700 mg/day 15kg -> 375-750 mg/day 16kg -> 400-800 mg/day 17kg -> 425-850 mg/day 18kg -> 450-900 mg/day 19kg -> 475-950 mg/day 20kg -> 500-1000 mg/day 21kg -> 525-1050 mg/day 22kg -> 550-1100 mg/day 23kg -> 575-1150 mg/day 24kg -> 600-1200 mg/day 25kg -> 625-1250 mg/day 26kg -> 650-1300 mg/day 27kg -> 675-1350 mg/day 28kg -> 700-1400 mg/day 29kg -> 725-1450 mg/day 30kg -> 750-1500 mg/day 31kg -> 775-1550 mg/day 32kg -> 800-1600 mg/day 33kg -> 825-1650 mg/day 34kg -> 850-1700 mg/day 35kg -> 875-1750 mg/day 36kg -> 900-1800 mg/day 37kg -> 925-1850 mg/day 38kg -> 950-1900 mg/day 39kg -> 975-1950 mg/day 40kg -> 1000-2000 mg/day 41kg -> 1025-2000 mg/day (upper capped) 42kg -> 1050-2000 mg/day (upper capped) 43kg -> 1075-2000 mg/day (upper capped) 44kg -> 1100-2000 mg/day (upper capped) 45kg -> 1125-2000 mg/day (upper capped) 46kg -> 1150-2000 mg/day (upper capped) 47kg -> 1175-2000 mg/day (upper capped) 48kg -> 1200-2000 mg/day (upper capped) 49kg -> 1225-2000 mg/day (upper capped) 50kg -> 1250-2000 mg/day (upper capped) Choice Alternatives, both oral antistaphylococcal cover for folliculitis that is extensive, deeper, or has not settled on the topical antibiotic. Cefalexin is put first for two reasons: the folliculitis source names it by name, and it can be bought plain in Egypt, where every flucloxacillin product on the market is a combination with amoxicillin or ampicillin. Cefalexin also carries the weight-based paediatric dose. Source Folliculitis - StatPearls - NCBI Bookshelf (NBK547754) - disease-level clinical article (bacterial-folliculitis-full.txt) for the indication - verbatim: "Should these prove ineffective or should the patient present with deeper folliculitis such as furunculosis and carbunculosis or more extensive involvement of the skin, then oral antibiotics such as cephalexin and dicloxacillin are options." The article gives no dose. Dose from Egyptian National Drug Formulary - Antimicrobial 2023, cephalexin monograph - verbatim indication "Skin and skin structure infections: Treatment of skin and skin structure infections caused by S. aureus and/or S. pyogenes", and dosing: "Usual adult dosage range: Oral: 250 to 1,000 mg every 6 hours or 500 mg every 12 hours (maximum: 4 g/day)". Why The oral step when a topical antibiotic is not enough or the infection has gone deeper. It is the source's first-named oral option and the one obtainable as a single medicine in Egypt. Caution Four times a day. A missed dose matters more on a 6-hourly antibiotic than on a twice- daily one - say so when handing it over. Avoid after a severe or immediate reaction to a penicillin. Tablets and oral suspension are not bioequivalent and must not be swapped milligram for milligram - Egyptian National Drug Formulary, cephalexin monograph. Spreading redness, fever, or a fluctuant swelling is cellulitis or an abscess, and needs reassessment or drainage rather than a longer oral course. Egypt CEFLODIX 500 MG 12 CAPS. ARAB CAPS > P... 9.00 EGP (0.75/unit) CEPHALEXCID 500 MG 12 CAPS. CID 10.30 EGP (0.86/unit) CEPHOXIN 500MG 12 TAB. PHARCO B 10.50 EGP (0.88/unit) CEPHALEXIN 500MG 10 CAPS. ARAB DRUG COM... 10.10 EGP (1.01/unit) MEDICEFLEXIN 500 MG 20 CAPS. T3A PHARMA > ... 25.25 EGP (1.26/unit) CEPHALEXIN 500MG 12 CAPS B.P.2007 SHIFA MEDICAL PRODUCTS > O... 27.00 EGP (2.25/unit) KEFLEX 500 MG 12 CAPS. HIKMA PHARMA 58.00 EGP (4.83/unit) CEPOREX 500MG 12 TABS. GLAXO SMITHKLINE 69.00 EGP (5.75/unit) AMTHROST 125MG/5ML SUSP. 60ML SIGMA > SABAA 4.00 EGP -> ? strength differs, ? different route - not oral solid AMTHROST 250MG/5ML SUSP. 60ML SIGMA > SABAA 4.50 EGP -> ? strength differs, ? different route - not oral solid ORAL ANTIBIOTIC - GRAM-NEGATIVE FOLLICULITIS 4. SULPHAMETHOXAZOLE + TRIMETHOPRIM [2nd line] Adult 1 to 2 double-strength tablets every 12 to 24 hours Peds 6-12 mg/kg/day [child max 320 mg] (From 2 months of age: 6 to 12 mg/kg a day of the trimethoprim component, split every 12 hours, up to 160 mg of trimethoprim per dose. Not for infants under 2 months.) 3kg -> 18-36 mg/day 4kg -> 24-48 mg/day 5kg -> 30-60 mg/day 6kg -> 36-72 mg/day 7kg -> 42-84 mg/day 8kg -> 48-96 mg/day 9kg -> 54-108 mg/day 10kg -> 60-120 mg/day 11kg -> 66-132 mg/day 12kg -> 72-144 mg/day 13kg -> 78-156 mg/day 14kg -> 84-168 mg/day 15kg -> 90-180 mg/day 16kg -> 96-192 mg/day 17kg -> 102-204 mg/day 18kg -> 108-216 mg/day 19kg -> 114-228 mg/day 20kg -> 120-240 mg/day 21kg -> 126-252 mg/day 22kg -> 132-264 mg/day 23kg -> 138-276 mg/day 24kg -> 144-288 mg/day 25kg -> 150-300 mg/day 26kg -> 156-312 mg/day 27kg -> 162-320 mg/day (upper capped) 28kg -> 168-320 mg/day (upper capped) 29kg -> 174-320 mg/day (upper capped) 30kg -> 180-320 mg/day (upper capped) 31kg -> 186-320 mg/day (upper capped) 32kg -> 192-320 mg/day (upper capped) 33kg -> 198-320 mg/day (upper capped) 34kg -> 204-320 mg/day (upper capped) 35kg -> 210-320 mg/day (upper capped) 36kg -> 216-320 mg/day (upper capped) 37kg -> 222-320 mg/day (upper capped) 38kg -> 228-320 mg/day (upper capped) 39kg -> 234-320 mg/day (upper capped) 40kg -> 240-320 mg/day (upper capped) 41kg -> 246-320 mg/day (upper capped) 42kg -> 252-320 mg/day (upper capped) 43kg -> 258-320 mg/day (upper capped) 44kg -> 264-320 mg/day (upper capped) 45kg -> 270-320 mg/day (upper capped) 46kg -> 276-320 mg/day (upper capped) 47kg -> 282-320 mg/day (upper capped) 48kg -> 288-320 mg/day (upper capped) 49kg -> 294-320 mg/day (upper capped) 50kg -> 300-320 mg/day (upper capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (sulfamethoxazole and trimethoprim monograph) - verbatim: "General dosing guidelines: Oral: 1 to 2 double-strength tablets every 12 to 24 hours." Why Gram-negative folliculitis, the form that follows a long course of antibiotics for acne, does not respond to the anti-staphylococcal agents listed above. Co-trimoxazole is the article's first-line oral choice for it and is cheap and everywhere in Egypt. Caution Do not use it in sulfonamide or trimethoprim allergy, in megaloblastic anaemia from folate deficiency, in marked liver damage, in severe kidney disease that cannot be monitored, or in an infant under 2 months. For gram-negative folliculitis, the kind that follows prolonged antibiotic treatment - not for ordinary staphylococcal folliculitis, which mupirocin, flucloxacillin and cefalexin already cover. The formulary does not list skin infection among co-trimoxazole's indications; the indication here rests on the disease article. Egypt CO-TRIMOXAZOLE 20 TABS. MUP 5.00 EGP (0.25/unit) COTRIL 400/80MG 20 TAB. EL NASR 38.00 EGP (1.90/unit) SEPTAZOLE FORTE 800/160MG 20 TABS. ALEXANDRIA 56.00 EGP (2.80/unit) SEPTRIN D.S 10 TABS. GLAXO SMITHKL... 28.00 EGP (2.80/unit) SEPTAZOLE 400/80MG 20*10 TABS. ALEXANDRIA 340.00 EGP (34.00/unit) SUTRIM 400/80MG 20*10 TAB. MEMPHIS 340.00 EGP (34.00/unit) CO-TRIMOXAZOLE 200/40MG SUSP. 120ML MUP 6.00 EGP -> ? strength differs, ? different route - not oral solid SUTRIM 200/40MG SUSP. 100ML MEMPHIS 18.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)