What is the recommended antibiotic for a nail bed infection?

From the Guidelines

For a nail bed infection, the recommended treatment is not an antibiotic, but rather an antifungal medication, as the infection is often caused by a fungal infection, specifically onychomycosis. The most effective treatment for onychomycosis is typically an oral antifungal medication, such as itraconazole or terbinafine, as recommended by the British Association of Dermatologists' guidelines for the management of onychomycosis 2014 1.

• Itraconazole is recommended as a first-line treatment, with a strength of recommendation A, and a suggested dosage of 200 mg per day for 12 weeks continuously, or alternatively as ‘pulse therapy’ at a dose of 400 mg per day for 1 week per month 1.
• Terbinafine is also recommended as a first-line treatment, with a strength of recommendation A, and a suggested dosage of 250 mg per day for 6 weeks in fingernail and 12–16 weeks in toenail infection 1.
• Fluconazole may be a useful alternative in patients unable to tolerate terbinafine or itraconazole, with a strength of recommendation B, and a suggested dosage of 150–450 mg per week for 3 months in fingernail infections and for at least 6 months in toenail infections 1. It's essential to note that the treatment of onychomycosis depends on the severity of the infection, the type of fungus causing the infection, and the patient's overall health.
• In addition to antifungal medication, good foot hygiene, and proper nail care can help prevent the spread of the infection and promote healthy nail growth.
• Patients with diabetes or immunocompromised conditions should seek medical attention promptly as they are at higher risk for complications.
• It's also important to monitor liver function tests and complete full blood count in adult patients with a history of hepatotoxicity or haematological abnormalities, as antifungal medications can have adverse effects on the liver and blood cells 1.

From the Research

Nail Bed Infection Antibiotics

• The recommended antibiotic for a nail bed infection depends on the causative agent of the infection 2.
• Bacterial infections of the nails are caused by gram-negative bacteria, such as Pseudomonas aeruginosa, and gram-positive bacteria, such as Staphylococcus aureus 2.
• For Pseudomonas infections of the nail organ, ciprofloxacin is used as treatment 2.
• Other bacteria are treated according to the results of culture and sensitivity testing 2.
• In cases of Staphylococcus aureus infections, penicillinase-resistant penicillins, such as flucloxacillin, are the antibiotics of choice for serious methicillin-susceptible S. aureus (MSSA) infections 3.
• For less serious MSSA infections, first-generation cephalosporins, clindamycin, lincomycin, and erythromycin have important therapeutic roles 3.
• Cephalexin is an effective antibiotic for the treatment of streptococcal and staphylococcal skin infections, including those of the nail unit 4.
• Amoxicillin-clavulanic acid is effective in eliminating Streptococcus pyogenes from a mixed infection with a beta-lactamase-producing strain of S. aureus 5.