From the Guidelines
For a nail bed infection, the recommended antibiotic is typically cephalexin, as it is listed as a first-choice antibiotic for mild skin and soft tissue infections, including those that may affect the nail bed, according to the WHO's essential medicines and aware recommendations 1.
Key Considerations
- The standard adult dosage for cephalexin is 500 mg orally four times daily.
- Treatment duration is generally 7-10 days.
- These antibiotics are effective because most nail bed infections (paronychia) are caused by Staphylococcus aureus or Streptococcus species, and cephalexin provides good coverage against these organisms.
Alternative Options
- For patients with penicillin allergies, clindamycin 300-450 mg orally four times daily is an alternative option.
- Dicloxacillin is also an option, but cephalexin is preferred due to its listing as a first-choice antibiotic.
Additional Treatment
- Warm water soaks for 15 minutes 3-4 times daily can help reduce inflammation and promote drainage.
- If pus is present, incision and drainage may be necessary before antibiotics will be effective.
- Patients should keep the affected area clean and dry between soaks and avoid trauma to the nail.
Monitoring and Follow-up
- If symptoms worsen despite 48 hours of antibiotic therapy, or if there are signs of a deeper infection such as red streaking up the arm or hand swelling, immediate medical reevaluation is necessary.
- It is essential to note that the Infectious Diseases Society of America guidelines recommend vancomycin, linezolid, clindamycin, daptomycin, ceftaroline, doxycycline, and sulfamethoxazole-trimethoprim for MRSA infections, or if this is highly suspected 1.
- However, for a typical nail bed infection without suspected MRSA, cephalexin remains a suitable first-line choice.
From the FDA Drug Label
Amoxicillin/clavulanic acid has been shown to be active against most isolates of the following bacteria, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section Gram-positive bacteria Staphylococcus aureus Gram-negative bacteria Enterobacter species Escherichia coli Haemophilus influenzae Klebsiella species Moraxella catarrhalis
The recommended antibiotic for a nail bed infection is amoxicillin-clavulanate (PO), as it has been shown to be active against a wide range of bacteria, including Staphylococcus aureus, which is commonly involved in skin and soft tissue infections, including nail bed infections 2.
- Key points:
- Amoxicillin-clavulanate has a broad spectrum of activity against Gram-positive and Gram-negative bacteria.
- It is effective against Staphylococcus aureus, a common cause of nail bed infections.
- The dosage and administration of amoxicillin-clavulanate should be determined by a healthcare professional, taking into account the severity of the infection and the patient's medical history.
From the Research
Nail Bed Infection Antibiotics
- The recommended antibiotic for a nail bed infection depends on the causative agent of the infection 3.
- Bacterial infections of the nails are caused by gram-negative bacteria, such as Pseudomonas aeruginosa, and gram-positive bacteria, such as Staphylococcus aureus 3.
- For Pseudomonas infections of the nail organ, ciprofloxacin is used as treatment 3.
- Other bacteria are treated according to the results of culture and sensitivity testing 3.
- 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 4.
- For less serious MSSA infections, first-generation cephalosporins, clindamycin, lincomycin, and erythromycin have important therapeutic roles 4.
- Cephalexin is an effective antibiotic for the treatment of streptococcal and staphylococcal skin infections, including those of the nail unit 5.
- Amoxicillin-clavulanic acid is effective in eliminating Streptococcus pyogenes from a mixed infection with a beta-lactamase-producing strain of S. aureus 6.