What antibiotic is recommended for a toenail avulsion infection?

From the Guidelines

For a toenail avulsion infection, the recommended first-line antibiotic is typically cephalexin (Keflex) 500 mg taken orally four times daily for 7-10 days, as suggested by the Infectious Diseases Society of America guidelines 1. This recommendation is based on the most recent and highest quality evidence available, which prioritizes the treatment of skin and soft tissue infections, including those caused by Staphylococcus aureus and Streptococcus species, common in toenail infections. Some key points to consider in the management of toenail avulsion infections include:

• The use of antibiotics such as cephalexin, dicloxacillin, or clindamycin, depending on the patient's allergy status and the suspected causative organism 1.
• Proper wound care, including daily cleaning with mild soap and water, application of an antiseptic solution, and covering with a sterile dressing.
• Soaking the affected foot in warm water with Epsom salt for 15 minutes twice daily to reduce inflammation and promote healing.
• Monitoring for signs of worsening infection, such as increasing redness, swelling, warmth, pain, or pus drainage, and seeking immediate medical reevaluation if necessary. It is essential to note that the treatment of toenail avulsion infections should prioritize morbidity, mortality, and quality of life as outcomes, and the choice of antibiotic should be guided by the most recent and highest quality evidence available 1.

From the FDA Drug Label

Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci Serious skin and soft tissue infections

The recommended antibiotic for a toenail avulsion infection is clindamycin (PO), but only if the infection is caused by susceptible bacteria, such as anaerobic bacteria, streptococci, pneumococci, or staphylococci.

• The choice of antibiotic should be based on bacteriologic studies to determine the causative organisms and their susceptibility to clindamycin.
• Local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy in the absence of culture and susceptibility data 2.

From the Research

Toenail Avulsion Infection Antibiotic Treatment

The treatment of toenail avulsion infections typically involves the use of antibiotics effective against common bacterial pathogens such as Staphylococcus aureus.

• For methicillin-susceptible S. aureus (MSSA) infections, penicillinase-resistant penicillins (e.g., flucloxacillin, dicloxacillin) are recommended 3.
• First-generation cephalosporins (e.g., cephalexin), clindamycin, lincomycin, and erythromycin may also be used for less serious MSSA infections or in patients with penicillin hypersensitivity 3, 4.
• For methicillin-resistant S. aureus (MRSA) infections, vancomycin or teicoplanin are recommended for serious infections, while lincosamides (e.g., clindamycin) or cotrimoxazole may be used for less serious infections 3, 5.
• Cephalexin has been shown to be effective in the treatment of staphylococcal skin and soft tissue infections, including those caused by MRSA 4, 6.

Considerations for Antibiotic Choice

When selecting an antibiotic for the treatment of a toenail avulsion infection, it is essential to consider the severity of the infection, the susceptibility of the causative organism, and the potential for antibiotic resistance.

• The use of broad-spectrum antibiotics should be reserved for severe infections or those caused by resistant organisms 5, 7.
• Antibiotic prophylaxis may be considered in certain situations, such as surgical procedures, to prevent infections caused by susceptible organisms 7.