From the Guidelines
For an ingrown toenail with signs of infection, oral antibiotics such as dicloxacillin 500 mg four times daily, cephalexin 500 mg four times daily, or clindamycin 300 mg four times daily for 7-10 days are commonly recommended. These antibiotics target the most common bacteria involved, particularly Staphylococcus aureus and Streptococcus species 1. It is essential to start treatment promptly when signs of infection appear, such as redness, swelling, warmth, pain, or pus.
While taking antibiotics, it's crucial to soak the affected foot in warm water with Epsom salt for 15-20 minutes 3-4 times daily, keep the area clean and dry, wear open-toed shoes if possible, and take over-the-counter pain relievers as needed. If symptoms worsen, include fever, or don't improve within 48-72 hours of antibiotic treatment, seek medical attention as you may need surgical intervention to remove part of the nail.
People with diabetes, peripheral vascular disease, or immunocompromised conditions should seek medical care immediately rather than attempting self-treatment, as they face higher risks of complications 2. The selection of an empiric antibiotic regimen should be based on the severity of the infection and the likely etiologic agent(s), and definitive therapy should be based on both the culture results and susceptibility data and the clinical response to the empirical regimen.
Key considerations for antibiotic therapy include:
- Selecting an appropriate antibiotic regimen based on the severity of the infection and the likely etiologic agent(s) 1
- Considering the risk of MRSA or other resistant organisms, especially in patients with a prior history of MRSA infection or in areas with high local prevalence 1
- Using parenteral therapy for severe infections, at least initially, and switching to oral agents when the patient is systemically well and culture results are available 1
- Continuing antibiotic therapy until there is evidence that the infection has resolved, but not necessarily until a wound has healed 2
From the Research
Treatment of Ingrown Toenail with Infection
The use of antibiotics for an ingrown toenail with signs of infection is a common consideration. However, the evidence suggests that antibiotics may not always be necessary.
- A study published in 2000 3 found that the use of oral antibiotics as an adjunctive therapy in treating ingrown toenails does not play a role in decreasing the healing time or postprocedure morbidity.
- Another study from 2009 4 states that oral antibiotics before or after phenolization do not improve outcomes.
- A 1995 study 5 mentions the use of topical or oral antibiotics as part of conservative approaches for patients with mild stage 1 disease.
Recommended Treatment Approaches
For ingrown toenails with infection, the following treatment approaches are recommended:
- Surgical approaches such as partial nail avulsion or complete nail excision with or without phenolization 4, 6.
- Conservative treatment approaches including soaking the foot in warm, soapy water; placing cotton wisps or dental floss under the ingrown nail edge; and gutter splinting with or without the placement of an acrylic nail 4.
- Podiatric treatment such as tamponades or sulci protectors can improve symptoms in mild cases 6.
Antibiotic Use
There is limited evidence to support the use of specific antibiotics for ingrown toenails with infection.