What are the first line antibiotics for paronychia?

From the Guidelines

The first-line antibiotic treatment for paronychia is typically oral dicloxacillin or cephalexin, as recommended by the Infectious Diseases Society of America in their 2014 guidelines 1. For mild cases of acute paronychia,

• dicloxacillin 250-500 mg four times daily
• or cephalexin 500 mg four times daily for 7-10 days is recommended. If the patient has a penicillin allergy,
• clindamycin 300-450 mg four times daily for 7-10 days is an appropriate alternative. For more severe infections or diabetic patients,
• amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days may be preferred due to broader coverage. These antibiotics target Staphylococcus aureus and Streptococcus species, which are the most common causative organisms. In addition to antibiotics,
• warm soaks 3-4 times daily for 15 minutes
• and drainage of any abscess are important components of treatment. If MRSA is suspected based on local prevalence or patient risk factors,
• trimethoprim-sulfamethoxazole or doxycycline may be more appropriate choices, as stated in the guidelines 1. Patients should be advised to
• keep the affected area dry between soaks
• and to avoid nail biting or finger sucking, which can worsen the infection. It's essential to note that the guidelines emphasize the importance of considering the presence or absence of systemic inflammatory response syndrome (SIRS) when deciding on antibiotic treatment, as this can impact the severity of the infection and the choice of antibiotic 1.

From the FDA Drug Label

Mupirocin is active against a wide range of gram-positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA). Mupirocin has been shown to be active against most strains of Staphylococcus aureus and Streptococcus pyogenes, both in vitro and in clinical studies.

The first line antibiotics for paronychia include mupirocin 2, due to its effectiveness against gram-positive bacteria, including MRSA.

• Mupirocin is a suitable option for the treatment of paronychia, especially when caused by susceptible strains of Staphylococcus aureus or Streptococcus pyogenes.
• Dicloxacillin 3 may also be considered for the treatment of paronychia, particularly in cases where the infection is suspected to be caused by Staphylococcus aureus.

From the Research

First Line Antibiotics for Paronychia

• The first line antibiotics for paronychia are not explicitly stated in the provided studies, but based on the information given, the following antibiotics can be considered:
  • Amoxicillin/clavulanate or clindamycin for broad-spectrum coverage, especially in cases of mixed anaerobic and aerobic infections 4
  • Penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) for methicillin-susceptible S. aureus (MSSA) infections 5
  • Clindamycin or cotrimoxazole for less serious non-multiresistant community-acquired MRSA infections 5
• In some cases, oral antibiotics such as clarithromycin may be prescribed, especially when bacterial paronychia is present 6
• It's essential to note that the choice of antibiotic should be based on the most likely pathogens and local resistance patterns, as well as the severity of the infection and the patient's overall health status 7, 4, 5

Specific Considerations

• For neonates with paronychia, broad-spectrum antibiotics such as amoxicillin/clavulanate or clindamycin may be considered, along with incision and drainage 4
• In cases of MRSA infections, vancomycin or teicoplanin may be used, and for non-multiresistant community-acquired MRSA infections, lincosamides or cotrimoxazole may be considered 5
• The use of topical antibiotics, such as those containing neomycin or bacitracin, may also be considered in conjunction with other treatments, such as warm soaks and topical steroids 7