Bacterial Skin Infections: Impetigo, Furuncles and Carbuncles

bacitracin Bacitracin Apply 1-3 times daily for up to 7 days or until all lesions are healed Common cause of allergic contact dermatitis Less effective than fusidic acid or mupirocin. Spectrum: Gram-positive only. Stable only in petrolatum (ointment). fusidic acid Fucidin Apply BID-TID × 5 days or until all lesions are healed Rare: Mild irritation, allergic contact dermatitis First-line treatment option. Spectrum: Gram-positive only. mupirocin Bactroban, generics Apply BID-TID × 5 days or until all lesions are healed Infrequent: burning, stinging Rare: Allergic contact dermatitis First-line treatment option. Spectrum: Gram-positive only. bacitracin/​neomycin/​polymyxin B Neosporin Ointment, generics Apply TID × up to 7 days or until all lesions are healed Neomycin and bacitracin components are common causes of allergic contact dermatitis Less effective than fusidic acid or mupirocin. Spectrum: Gram-positive and gram-negative. Rarely nephrotoxic when applied to large denuded areas. bacitracin/​gramicidin/​polymyxin B Polysporin Products, generics Apply TID × up to 7 days or until all lesions are healed Bacitracin component is a common cause of allergic contact dermatitis Less effective than fusidic acid or mupirocin. Spectrum: Gram-positive and gram-negative. Rarely nephrotoxic when applied to large denuded areas.

GENERAL DRUGS

Avoid close contact with people who have impetigo. Keep any scratches or cuts very clean and covered with bandages. Tell children not to touch or pick the sores. Touching the sores can spread the infection. Be sure to wash hands well with alcohol-based cleansers or soap and warm water after treating the impetigo. Wash and change the infected person's clothes, towels and bedding daily for the first 2 days of antibiotic treatment. After 2 days of antibiotic treatment, the impetigo will no longer be contagious.

How can you prevent impetigo from spreading?

The pus is contagious. It can spread the infection to other parts of the skin or to other people. Wash your hands with alcohol-based hand cleansers or antibacterial soap after touching the boils. Shower and wash your hair every day with antibacterial soap. This will help to decrease bacteria on the skin and reduce the chance of boils spreading. Wash washcloths, towels or clothes that touched the boils in hot soapy water. Dry them in the hot cycle of the dryer. Do not share facecloths and towels. Antibiotic ointments or creams will not heal boils but they may help prevent the boils from spreading.

How can you prevent the spread of boils?

A single boil can usually be treated at home. See a healthcare provider if you develop carbuncles. Apply a warm compress (a clean washcloth soaked in warm water) to the boil for 20-30 minutes. Do it 3 times a day. It will help the boil to come to a "head." Clean the boil with antiseptic soap and cover it with a loose gauze dressing. The boil will usually burst and drain on its own. It may take several days for it to drain completely. Be sure to keep it covered to prevent the infection from spreading. The boil will be very painful until it drains. Do not squeeze the boil—the bacteria may spread into your blood and cause a more serious infection.

How do you treat boils?

A person can get impetigo by touching the infected area or by using the same towel, cup or glass as an infected person.

How does impetigo spread?

After spontaneous or surgical drainage, healing usually occurs within a week. Large lesions may heal with a scar. Patients with recurrent infections may have underlying systemic illnesses that require investigation and management. Boils and pus No more drainage of pus, and lesions heal over several weeks. If no improvement or worsening by day 3, patient requires further assessment and/or treatment. Fever If no improvement by day 2, patient requires further assessment and/or treatment. Pain on palpation If no improvement or worsening by day 3, patient requires further assessment and/or treatment. Recurrent lesions Patient: Watch for any new lesions for weeks and months following the initial lesions Patient requires culture of anterior nares and perineum. Patient may require assessment and/or treatment for underlying causes of recurrence. Allergy to topical agents Stop therapy. Patient requires further assessment and/or treatment. Irritation caused by topical agents Healthcare practitioner: After 1 wk or next visit Little to no irritation that subsides with continued use. Stop therapy if no improvement in irritation after several doses.

Monitoring of Therapy

Lesions should begin to heal within 2-3 days of starting therapy, and the patient is no longer infectious about 48 hours after the initiation of treatment. Lesions usually heal without scarring. Further assessment and/or treatment is advised if lesions spread, or if fever or other systemic symptoms arise. Vesicles and crusts Clearing of all lesions by 7-10 days. Return of normal skin appearance within 2-3 wk. If worsening or no improvement by day 3, consider further assessment and/or treatment. Bullous lesions Clearing of all lesions. Return of normal skin appearance within 2-3 wk. If worsening or no improvement by day 3, consider further assessment and/or treatment. Reddish-brown or "cola" coloured urine (possible indicator of post-streptococcal glomerulonephritis) No renal problems. Patient requires immediate assessment for renal evaluation. Allergy to topical agents Stop therapy. Patient requires further assessment and/or treatment. Irritation caused by topical agents Little to no irritation that subsides with continued use. Stop therapy if no improvement in irritation after several doses.

Monitoring of Therapy

Boils are skin infections that causes painful, red, pus-filled swellings around the base of hair strands. Boils are also called furuncles. If the infection spreads, you may get very large boils or groups of boils, called carbuncles. People with diseases such as diabetes, kidney or liver disease are more likely to get boils because their resistance to disease is low.

What are boils(FURUNCLES)?

The first sign of infection is a tiny white- or yellow-headed pimple at the base of a hair strand. This condition is called folliculitis. The infection can spread wider and deeper into the skin to cause a painful, red swelling (lump) that is about 1 or 2 cm wide. This is a boil or furuncle. After several days, the centre of the boil becomes soft and filled with pus. Eventually, this pus will drain and relieve the pain. Carbuncles cause similar symptoms but they are more severe. Boils most commonly occur in hairy, moist areas of the body such as the back of the neck, face, armpits and buttocks.

What are the symptoms?

Impetigo is a contagious skin infection caused by bacteria. Children get impetigo more often than adults, but adults can get it too. Impetigo usually appears around the nose and mouth. It can also show up on other parts of the body where the skin has been broken, such as cuts, scrapes or insect bites.

What is impetigo?

Antibiotic ointments that contain polymyxin B and bacitracin or gramicidin can be bought from the pharmacist. Use if there are only 1 or 2 recent, small spots. If the spots spread, see your healthcare provider; you may need a different antibiotic. How to use antibiotic ointment: Remove any crusts from the skin before applying the antibiotic ointment. Use a clean cloth soaked in warm soapy water or saline (salt) solution. Apply the warm cloth to the area for 10-15 minutes then gently scrub off the crusts. Apply the ointment directly to the infected area 3 times a day until the spots are healed. This may take 5-7 days. Cover the draining sores lightly with gauze and tape to avoid spreading the infection.

What is the treatment for impetigo?

If the boil has come to a head and needs to be opened for it to drain. Do not do this yourself. If carbuncles form you may need a prescription for antibiotics. If you feel sick and you have a fever. If your boils come back or other family members also develop boils.

When should you see your healthcare provider?

If the impetigo is more than just a few small spots. You may need a different antibiotic. If the skin does not begin to heal after 3 days of treatment. If the infected person develops a fever. If the infected area gets worse—becomes red, warm or painful.

When should you see your healthcare provider?