What are the recommended first-line treatments for a patient presenting with a boil or carbuncle in primary care?

First-line treatment for a boil or carbuncle in primary care typically involves incision and drainage as the primary management step to remove pus and relieve symptoms.

Antibiotics are not routinely required for uncomplicated boils or carbuncles but should be considered if there is surrounding cellulitis, systemic symptoms, or the patient is at increased risk of complications (e.g., immunosuppression, diabetes).

When antibiotics are indicated, flucloxacillin is the first-choice oral antibiotic to cover likely causative organisms such as Staphylococcus aureus.

In cases of penicillin allergy, co-trimoxazole or clarithromycin may be used as alternatives.

Patients should be advised on wound care, hygiene, and to seek medical help if symptoms worsen or do not improve within a few days.

Referral to specialist care is warranted if there is extensive infection, systemic illness, or failure to respond to initial treatment.

This approach aligns with NICE guidance on managing skin and soft tissue infections in primary care, emphasising incision and drainage as the mainstay and reserving antibiotics for more severe or complicated cases.

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