Dawaa Reference

infectious

Boil and Furuncle

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

IDSA Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections 2014 · Egyptian National Drug Formulary - Antimicrobial 2023 · IDSA Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections, 2014 update · IDSA Clinical Practice Guidelines for the Treatment of MRSA Infections in Adults and Children, 2011 · Egyptian National Drug Formulary - Antimicrobial 2023 (mupirocin monograph)

Verified against3 documents
  • IDSA Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections, 2014 update
  • Egyptian National Drug Formulary - Antimicrobial 2023
  • IDSA Clinical Practice Guidelines for the Treatment of MRSA Infections in Adults and Children, 2011

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • A slowly growing, tender lump that began as a small pustule becomes fluctuant over days to weeks [pustules · skin nodule]
  • Systemic features such as swollen regional nodes, fever, fatigue, or malaise can accompany it but are not required [fatigue · fever · malaise]
  • The ladder runs folliculitis first, then a furuncle if it is left untreated, and a carbuncle once several furuncles sit against each other [abscess]
  • A carbuncle is two or more furuncles running together [abscess]

Signs — what you find (5)

  • A painful red nodule studded with several overlying pustules, which rupture easily and crust over [pustules]
  • Most often found on the neck nape, face, back, buttocks, axillae, or groin
  • It is an infection of the hair follicles that reaches into the surrounding skin and down into the deep subcutaneous tissue
  • The carbuncle is red, tender, inflamed and fluctuant, with several draining sinus tracts or pustules on its surface [abscess · pustules]
  • They favour thicker skin - the back of the neck, the back and the thighs - though they can appear anywhere hair grows

Tests (2)

  • Pus culture and sensitivity, taken before antibiotics start, guides therapy and screens for MRSA or gram-negative organisms
  • A complete blood count is checked when systemic symptoms exist, and HbA1c or fasting glucose if diabetes is suspected

If not this — what else fits (7)

  • Cystic acne runs smaller, usually with a single pustule or none at all
  • Hidradenitis suppurativa stays limited to the axilla or groin and follows a more chronic course
  • Cellulitis lacks pustules and does not form a discrete nodule
  • Osteomyelitis tends to sit over a joint and is excluded with MRI
  • Orf is a self-limited viral disease with six staged phases, seen in people handling sheep or farm animals
  • Cutaneous anthrax follows farm-animal or bioterrorism exposure and develops a black eschar
  • Arthropod bites tend to occur as multiple lesions and appear more acutely

SourceStatPearls "Carbuncle" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Topical antibiotic alongside drainage

MAIN TREATMENT - choose one

1

WARM COMPRESSES & INCISION & DRAINAGE (PRIMARY CARE STRATEGY)

1st line
Adult dose and duration

Apply warm moist compresses for 15-20 minutes 3-4 times daily to promote spontaneous drainage for small uncomplicated furuncles (< 2 cm). Perform surgical incision and drainage for fluctuant, painful, or larger abscesses. Systemic antibiotics are NOT required for simple localized drained boils without cellulitis. x 5-7 days PRN

Paediatric dose

Warm compresses and drainage for small boils in children; assess for surrounding erythema or systemic features.

Dose source

IDSA Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections, 2014 update

Why

Incision and drainage is the primary and definitive treatment for fluctuating furuncles; systemic antibiotics provide no added benefit for small, uncomplicated drained lesions without surrounding cellulitis or systemic symptoms.

Cautions
  • Incision and drainage is the primary definitive treatment for fluctuant boils.
  • Indicate systemic antibiotics if surrounding cellulitis (> 2 cm), systemic signs (fever, tachycardia), facial location (risk of cavernous sinus thrombosis), immunosuppression, or severe diabetes are present.
  • Never squeeze or compress facial boils in the nasolabial triangle ('danger triangle of the face').
  • The compress routine and the 2 cm threshold are ordinary practice, not guideline text - IDSA gives neither. What IDSA does say is that incision and drainage is the treatment for a carbuncle, an abscess or a large furuncle, and that whether to add an antibiotic turns on systemic inflammatory response.
2

CEFADROXIL

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

1 g daily, as a single dose or in 2 divided doses, for 7 days for boils with surrounding cellulitis, systemic symptoms, or high-risk locations x 7 days

Paediatric dose

30 mg/kg/day [child max 1000 mg]

(30 mg/kg/day in 2 divided doses for 7 days.)

Dose by weight
3kg90 mg/day
4kg120 mg/day
5kg150 mg/day
6kg180 mg/day
7kg210 mg/day
8kg240 mg/day
9kg270 mg/day
10kg300 mg/day
11kg330 mg/day
12kg360 mg/day
13kg390 mg/day
14kg420 mg/day
15kg450 mg/day
16kg480 mg/day
17kg510 mg/day
18kg540 mg/day
19kg570 mg/day
20kg600 mg/day
21kg630 mg/day
22kg660 mg/day
23kg690 mg/day
24kg720 mg/day
25kg750 mg/day
26kg780 mg/day
27kg810 mg/day
28kg840 mg/day
29kg870 mg/day
30kg900 mg/day
31kg930 mg/day
32kg960 mg/day
33kg990 mg/day
34kg1000 mg/day (capped)
35kg1000 mg/day (capped)
36kg1000 mg/day (capped)
37kg1000 mg/day (capped)
38kg1000 mg/day (capped)
39kg1000 mg/day (capped)
40kg1000 mg/day (capped)
41kg1000 mg/day (capped)
42kg1000 mg/day (capped)
43kg1000 mg/day (capped)
44kg1000 mg/day (capped)
45kg1000 mg/day (capped)
46kg1000 mg/day (capped)
47kg1000 mg/day (capped)
48kg1000 mg/day (capped)
49kg1000 mg/day (capped)
50kg1000 mg/day (capped)
Choice

Alternatives. The entry's rationale names cefadroxil the first-line systemic agent; clindamycin is the oral alternative when a cephalosporin cannot be used. Cefadroxil is also far cheaper.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

First-generation oral cephalosporin with reliable anti-staphylococcal activity, used as first-line systemic therapy when a boil has surrounding cellulitis, systemic symptoms, or is in a high-risk location; cheap and widely stocked in Egypt.

Cautions
  • 1 g a day is the whole skin dose. 500 mg twice daily reaches it; 1 g twice daily is double it and is the urinary-tract figure, not the skin one.
  • First-line oral anti-staphylococcal systemic antibiotic for complicated furuncles/carbuncles in Egyptian primary care.
  • Take with or without food; maintain consistent dosing intervals.
  • Use with caution in patients with penicillin allergy (1-10% cross-reactivity risk for 1st gen cephalosporins).
Egyptian brands
Egyptian brandManufacturerIndicative price
MEGADROXIL 500 MG 8 CAPS.SHIFA MEDICAL PRODUCTS > MASH PREMIERE4.50 EGP (0.56/unit)
CEFADROXIL 500MG 8 CAPS.SIGMA7.50 EGP (0.94/unit)
DURABIOTIC 500MG 8 CAPS.LOGESTIC PHARMA FOR PHARMACEUTICALS9.00 EGP (1.12/unit)
BIODROXIL 500MG 8 CAPS.KAHIRA > NOVARTIS10.50 EGP (1.31/unit)
LONGICEF 500 MG 8 CAPS.KAHIRA15.00 EGP (1.88/unit)
CURISAFE 500MG 8 CAPS.PHARCO B45.00 EGP (5.62/unit)
DURICEF 500MG 12 CAPS.SMITHKLINE BEECHAM72.00 EGP (6.00/unit)
LONGICEF 125MG/5ML SUSP. 60 ML? strength differs? different route - not oral solidKAHIRA4.25 EGP
CEFADROXIL 250MG/5ML PD. FOR ORAL SUSP. 60ML? strength differs? different route - not oral solidSIGMA7.50 EGP
3

CLINDAMYCIN

2nd line

Strength300 mg

Formoral.solid

Adult dose and duration

300 mg to 450 mg orally three times daily for 7 days for penicillin/cephalosporin-allergic patients or suspected MRSA x 7 days

Paediatric dose

10-25 mg/kg/day [child max 1350 mg]

(10-25 mg/kg/day in 3-4 divided doses for 7 days.)

Dose by weight
3kg30-75 mg/day
4kg40-100 mg/day
5kg50-125 mg/day
6kg60-150 mg/day
7kg70-175 mg/day
8kg80-200 mg/day
9kg90-225 mg/day
10kg100-250 mg/day
11kg110-275 mg/day
12kg120-300 mg/day
13kg130-325 mg/day
14kg140-350 mg/day
15kg150-375 mg/day
16kg160-400 mg/day
17kg170-425 mg/day
18kg180-450 mg/day
19kg190-475 mg/day
20kg200-500 mg/day
21kg210-525 mg/day
22kg220-550 mg/day
23kg230-575 mg/day
24kg240-600 mg/day
25kg250-625 mg/day
26kg260-650 mg/day
27kg270-675 mg/day
28kg280-700 mg/day
29kg290-725 mg/day
30kg300-750 mg/day
31kg310-775 mg/day
32kg320-800 mg/day
33kg330-825 mg/day
34kg340-850 mg/day
35kg350-875 mg/day
36kg360-900 mg/day
37kg370-925 mg/day
38kg380-950 mg/day
39kg390-975 mg/day
40kg400-1000 mg/day
41kg410-1025 mg/day
42kg420-1050 mg/day
43kg430-1075 mg/day
44kg440-1100 mg/day
45kg450-1125 mg/day
46kg460-1150 mg/day
47kg470-1175 mg/day
48kg480-1200 mg/day
49kg490-1225 mg/day
50kg500-1250 mg/day
Dose source

IDSA Clinical Practice Guidelines for the Treatment of MRSA Infections in Adults and Children, 2011

Why

Lincosamide antibiotic with anti-staphylococcal and anti-MRSA activity, used as the oral alternative to cefadroxil for boils in patients with penicillin or cephalosporin allergy or when community-acquired MRSA is suspected.

Cautions
  • Oral option for patients with severe penicillin allergy or suspected community-acquired MRSA.
  • Discontinue immediately if severe or persistent diarrhea occurs due to risk of Clostridioides difficile-associated colitis.
  • The paediatric band here is the ordinary skin-infection dose. If MRSA is the reason clindamycin was chosen, IDSA gives children 10-13 mg/kg per dose every 6-8 hours - roughly 30-40 mg/kg/day, well above the low end of this band.
Egyptian brands
Egyptian brandManufacturerIndicative price
ADCOCLINDACE 300 MG 16 CAPS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.50/unit)
CLINACYN 300MG 16 CAPS.SIGMA > EGYPTIAN PHARMACISTS COMPANY31.50 EGP (1.97/unit)
CLINDAM 300 MG 16 CAPS.SIGMA > OCTOBER PHARMA75.00 EGP (4.69/unit)
MEPACLIND 300MG 8 CAPS.MEPACO38.00 EGP (4.75/unit)
CLINDACINE ART 300 MG 12 CAPS.RAMEDA > ART PHARMA76.00 EGP (6.33/unit)
ALFACLINDAMYCIN 300 MG 10 CAPS.ATCO PHARMA > ROTABIOGEN69.00 EGP (6.90/unit)
DALACIN C 300MG 10 CAPS.PFIZER114.00 EGP (11.40/unit)
KLENDABIOTICAM 1 % TOP. SOLUTION? strength differs? different route - not oral solidPANAX PHARMA8.50 EGP
ADCOCLINDACE 10MG/ML TOP. SOL.? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)12.00 EGP

TOPICAL ANTIBIOTIC ALONGSIDE DRAINAGE - give alongside

4

MUPIROCIN

Topical antibiotic alongside drainage

add-on - not a substitute

Formtopical

Adult dose and duration

Apply the 2% ointment or cream to the affected area 2 to 3 times daily. x 7 to 14 days, depending on severity and response; reassess if no better after 3 to 5 days

Paediatric dose

Infants, children and adolescents: apply a small amount three times daily for 5 to 10 days, and review the child if there is no improvement by day 5.

Dose source

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

Drainage stays the main treatment, but the article lists a topical antibiotic as an add-on. The article also describes mupirocin for clearing nasal staphylococcal carriage in the patient whose boils keep recurring.

Cautions
  • For external use only - keep it off the eyes and off mucous membranes, because the base can be absorbed and cause drying and irritation.
  • Stop it if the skin becomes irritated or sensitised, or if a systemic allergic reaction develops.
  • Do not use it for weeks on end: prolonged use encourages fungal or resistant bacterial overgrowth.
  • It does not replace incision and drainage - a fluctuant boil still needs draining.
Egyptian brands
Egyptian brandManufacturerIndicative price
BACTROFORM 2% TOP. OINT. 15 GMWESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA35.00 EGP
MUPIROCIN SAJA 2% TOP. OINT. 15 GMBIOPHARM EGYPT > SAJA PHARMA35.00 EGP
MUPIRAX 2% OINT. 10 GMGLOBAL NAPI PHARMACEUTICALS48.00 EGP
MUPIROCIN SAJA 2% TOP. OINT. 20 GMBIOPHARM EGYPT > SAJA PHARMA83.00 EGP
MUPIRAX 2% OINT. 30 GMGLOBAL NAPI PHARMACEUTICALS118.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.