Carbuncle Treatment: Antibiotics, Drainage, and Wound Care

A carbuncle is a coalesced cluster of furuncles (boils) with deep subcutaneous infection, usually Staphylococcus aureus.

Medical Management

1. Antibiotics (systemic): Cover MSSA and MRSA per local epidemiology.
   • MSSA: Cephalexin, dicloxacillin, clindamycin
   • MRSA: TMP-SMX, doxycycline, clindamycin (if susceptible), linezolid
2. Incision and drainage (I&D): Essential for fluctuant collections. Performed under local anesthesia; may need packing.
3. Warm compresses: 15 min, 3–4×/day to promote drainage.
4. Pain control: NSAIDs; opioids if severe.
5. Wound care: Daily dressing changes, keep clean.
6. Follow-up: Monitor healing, adjust antibiotics per culture.

Red Flags—Seek Immediate Care

• Fever, chills, tachycardia
• Spreading cellulitis, lymphangitis
• Immunocompromised host
• Face/neck location (cavernous sinus risk)

Do not squeeze or self-drain—risk of bacteremia and metastatic infection.