What are the discharge instructions for a patient with paronychia who has undergone Incision and Drainage (I&D) and received antibiotics in an urgent care setting?

From the Guidelines

After incision and drainage of paronychia, patients should keep the affected area clean and dry, changing the dressing daily or when soiled, and soak the finger in warm water with Epsom salt for 15 minutes 3-4 times daily to promote healing and reduce inflammation, as recommended by recent guidelines 1. The goal of these discharge instructions is to prevent reinfection, promote healing, and ensure complete eradication of bacteria, thereby preventing antibiotic resistance and recurrence of infection.

• Keep the affected area clean and dry, changing the dressing daily or when soiled.
• Soak the finger in warm water with Epsom salt for 15 minutes 3-4 times daily to promote healing and reduce inflammation.
• Complete the full course of prescribed antibiotics, typically a 7-10 day regimen of medications like cephalexin 500mg four times daily or clindamycin 300mg three times daily if penicillin-allergic, as suggested by the guidelines for managing paronychia 1.
• Take over-the-counter pain relievers such as acetaminophen 650mg every 6 hours or ibuprofen 600mg every 6 hours as needed for pain.
• Elevate the affected hand when possible to reduce swelling.
• Return for follow-up in 48-72 hours to ensure proper healing.
• Seek immediate medical attention if you develop increasing pain, redness, swelling, fever above 101°F, red streaking from the wound, or pus drainage, as these could be signs of complications or worsening infection 1. It is essential to follow these instructions carefully to ensure the best possible outcome and prevent potential complications, as supported by the most recent and highest quality study on the management of paronychia 1.

From the Research

Discharge Instructions for Paronychia after I&D and Antibiotics

• The patient should be advised to keep the affected area clean and dry to promote healing and prevent further infection 2.
• The patient should be instructed to soak the affected finger or toe in warm water for 15-20 minutes, 2-3 times a day, to help reduce pain and swelling.
• The patient should be advised to take the prescribed antibiotics as directed and to complete the full course of treatment, even if symptoms improve before finishing the medication.
• The patient should be instructed to monitor the affected area for signs of infection, such as increased redness, swelling, or pus, and to seek medical attention if these symptoms occur.
• The patient should be advised to follow up with a healthcare provider in 2-3 days to check on the healing progress and to remove any sutures or packing material.
• The patient should be instructed to avoid biting or picking at the nail or surrounding skin, as this can lead to further irritation and infection.
• The patient should be advised to wear gloves when engaging in activities that may expose the hands to harsh chemicals or irritants, such as gardening or cleaning.