What is the dose of Keflex (Cephalexin) for toe paronychia?

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Last updated: February 20, 2025View editorial policy

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From the Guidelines

For toe paronychia, the recommended dose of Keflex (Cephalexin) is 20 mg per kg per dose twice daily, with a maximum of 500 mg per dose, for 10 days. This dosage is based on the strongest and most recent evidence available, specifically the 2013 IDSA guideline update for managing group A streptococcal pharyngitis, which provides a strong, high-quality recommendation for the use of Cephalexin in patients with penicillin allergy 1. The following key points support the use of this dosage:

  • The dosage provides adequate coverage against common causative bacteria, including Staphylococcus aureus and Streptococcus species.
  • The twice-daily dosing ensures consistent antibiotic levels in the body. Additional recommendations for managing toe paronychia include:
  • Keeping the affected area clean and dry
  • Soaking the toe in warm water with Epsom salt for 15 minutes, 3-4 times daily
  • Applying a topical antibiotic ointment after soaking
  • Wearing comfortable, well-fitting shoes to avoid pressure on the affected toe It is essential to note that if symptoms worsen or don't improve after 2-3 days of treatment, consultation with a healthcare provider is necessary, as incision and drainage may be required. Diabetic patients or those with severe infections may require different management. The effectiveness of Keflex in treating toe paronychia can be attributed to its mechanism of action, which involves inhibiting bacterial cell wall synthesis, leading to cell death, and its good oral absorption and distribution to soft tissues, making it suitable for skin and nail bed infections.

From the FDA Drug Label

The usual adult dose is 250 mg every 6 hours For the following infections, a dosage of 500 mg may be administered every 12 hours: streptococcal pharyngitis, skin and skin structure infections, and uncomplicated cystitis in patients over 15 years of age.

The dose of Keflex (Cephalexin) for skin and skin structure infections, which includes toe paronychia, is 250 mg every 6 hours or 500 mg every 12 hours 2.

From the Research

Dose of Keflex (Cephalexin) for Toe Paronychia

There are no research papers to assist in answering this question. The provided studies 3, 4, 5, 6, 7 discuss the treatment of onychomycosis, a fungal infection of the nail, with various antifungal medications such as terbinafine, itraconazole, and fluconazole. However, they do not provide information on the dose of Keflex (Cephalexin) for toe paronychia, which is a bacterial infection of the nail fold.

  • The studies focus on the efficacy of different dosing regimens for antifungal medications in the treatment of onychomycosis.
  • They do not mention Keflex (Cephalexin) or its use in treating toe paronychia.
  • Therefore, there is no relevant information available to answer the question regarding the dose of Keflex (Cephalexin) for toe paronychia based on the provided studies 3, 4, 5, 6, 7.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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