Brief Answer:
Recurrent furunculosis; cetrimide scalp wash

Detailed Answer:
Hello. Thanks for writing to us again.

Most likely you are a carrier of staph aureus.
As I have also mentioned in my previous replies to you that recurrent/chronic furunculosis is common in those who are "carriers" of Staph aureus.

If I was the treating doctor I would have suggested a pus culture and sensitivity test, from one of the furuncle which would identify antibiotic sensitivity of the bacterium.
Since staph can colonize various body sites; therefore, swabs should also be taken from the nose, throat, umbilicus, axilla and perineum to determine carrier state. Culture and sensitivities are required.

Nasal carrier state is common in those who have recurrent furunculosis. This can be eradicated by application of topical 2% mupirocin ointment, twice daily, to the opening or just inside the nares for 5 days.This eradicates carrier state for 3 months.

In recurrent/ chronic furunculosis the choice of oral antibiotic ideally should be guided by culture sensitivity tests. Empirical therapy with a penicillin group (e.g flucloxacillin) can be started till sensitivity report is awaited.

I would suggest you to visit a skin specialist in your region for culture sensitivity investigation as well as a prescription (topical as well as oral antibiotics)

Once your culture and antibiotic sensitivity results become available, your treating doctor would guide future therapies based on that report.
Eradication of carrier state may need a longer course, perhaps six or eight weeks antibiotics.

General measures that might prove useful are:

-Avoid hair oil.
-Twice daily bathing with an antibacterial soap, preferably that which contains chlorhexidine would be useful.
-Cetrimide based shampoo every alternate days. Cetrimide is an antiseptic (20% cetrimide is available as a liquid on prescription. It can be used as a scalp wash)
-Frequent hand washing with soap or alcohol based hand sanitizer.
-Wash sheets and undergarments regularly in a hot wash (above 55°C). The clothes should be turned inside out.
-Keep surroundings clean.
-Other members in the family should also be identified for carrier state and overt infections.

Regards

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Brief Answer:
Discontinue oral antibiotics till culture testing

Detailed Answer:
Hi.

Bactrim is trimethoprim/sulphamethoxazole which is effective against staph aureus.
Therefore, you should go for a pus culture test, first of all. Continuing oral antibiotics before the culture test may not reveal/isolate the causative bacterium from the pus.
Once you get this test done, thereafter empiric oral antibiotic may be continued pending culture report.
As you have been recently taking oral trimethoprim/sulphamethoxazole, therefore your culture form should specifically mention about your current and past antibiotic therapies, so that the testing lab specifically tests for the antimicrobial sensitivity against these antibiotics as well.
Trimethoprim/sulphamethoxazole would be effective but you should discontinue it for the time being till you get pus culture sensitivity testing done. Thereafter it may be continued in consultation with your treating physician.

Regards

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