Seek specialist advise if there is the possiblity of PVL-SA particularly in severe or recurrent boils or who reside in a household or institutional setting where outbreaks of boils/carbuncles have been noted. MRSA - suspect if the person has been hospitalized within the last year, or has a chronic illness requiring health care visit, history of MRSA, in an institutional setting, or had contact with someone known to have MRSA.

Prescribe a 7-day course of oral antibiotics if the person has a fever, cellulitis, lesion on the face, is in pain or severe discomfort, or there are other co-morbidities such as diabetes/immunosupression. Flucloxacillin is recommended first line (see other options in pregnancy/penicillin allergy).

Apply moist heat 3-4 times per day to alleviate pain, localize the infection and hasten drainage. Small boils may drain spontaneously - cover with sterile dressing to prevent autoinoculation. Seek advice if lesion becomes fluctuant or they become systemically unwell/cellulitis.

Giver information and self-care advice - Paracetamol/Ibuprofen as required for pain relief, maintain good personal hygiene, wash hands carefully after contact with lesions, wash/tumble dry underclothes, bed liner and towels at a high temperature, use separate face cloth/towel, wear loose fitting clothes, keep wounds/grazes clean and covered and do not participate in contact sports, swimming or attend the gym until healed.

Swab: not responding to treatment, persistent/recurrent to exclude atypical mycobacteria or PVL-SA, multiple lesions, the person is immunocompromised, MRSA, diabetes, or resides in a pace with recurrent outbreaks of skin/soft tissue infections have been reported.

In recurrent lesions: exclude/manage underlying causes where appropriate, ask if they have close contact with an infection person, confirm if they/family member works in a hospital/health care setting, swab the lesion, if PVL-SA is suspected mention on lab form and reinforce self-advice.

Consider admission if systemically unwell, cellulitis, infection where complications can be serious (such as face), or immunocompromised.

Arrange urgent same-day incision/drainage of all large and/or fluctuant boils, and all carbuncles. This can sometimes be carried out in primary care otherwise admitted via surgical unit/A&E.

All requiring decolonization skin treatment - use antiseptic prepartion daily as liquid soap in the bath/shower/sink for 5 days, avoid diluting in water, apply directly to wet skin, allow to remain on the skin for 1 minute, rinse off thoroughly and dry skin well, use shampoo on the first/third and fifth day, avoid using regular soap in addition to the antiseptic during baths/shower, pay particular attention to the axillae, groins, buttocks, under the breasts and the hands. During 5 days of treatment - change bedding and towels daily, wash on hot wash cycle with clothes turned inside out, vaccum/dust regularly, avoid bar soaps, clearning sink/bath regularly.

Recurrent - check if family members are hospita/health care worker, consider underlying causes, extend areas for swabbing, specifically request testing for PVL-SA, identify/treat potential sources of infection in the family/close contacts, screen household members if they are willing to co-operate in eradication strategy, for MRSA see individual topic, for PVL-SA discuss with microbiology.

Confirmed PVL skin infection - discuss management with microbiology or the local infection control team

Nasal carriage - Naseptin cream four times a day for 10 days. Alternatives available if unsuitable.

Advise to shower/bath daily, wash hand regularly, change clothes/underwear regularly, avoid sharing towels/ face cloths/razors/water bottles, wash sports clothes after each use, use disposable tissues and avoid picking the nose and sit on a clean towel in a sauna/wash after use.

Do not start decolonization until acute infection is resolved.

If staphylococcal carriage is suspected - take swabs from the contents of the boil or carbuncle, if recurrent presentations are localized to the facial area swab the nasal cavity, if more extensive consider swabbing the perineum, groin, axillae and umbilicus in addition to the nose.