What antibiotic is best for an ingrown toenail?

From the Guidelines

For an infected ingrown toenail, oral antibiotics like amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) are typically recommended, as suggested by the most recent guidelines 1. This recommendation is based on the latest evidence from the WHO's essential medicines and aware: recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections, which lists amoxicillin-clavulanate as a first-choice antibiotic for mild skin and soft tissue infections, including those caused by Staphylococcus aureus and Streptococcus species, common pathogens in ingrown toenail infections 1. Some key points to consider when treating an infected ingrown toenail include:

• The use of oral antibiotics, such as amoxicillin-clavulanate, to target the underlying bacterial infection 1
• The importance of removing the ingrown portion of the nail (partial nail avulsion) to allow for proper drainage and healing, often performed by a healthcare provider
• Soaking the foot in warm water with Epsom salt for 15-20 minutes several times daily to reduce pain and inflammation
• Applying antibiotic ointment, such as mupirocin or bacitracin, to the affected area to help prevent further infection
• Wearing loose-fitting shoes to reduce pressure on the toe and promote healing It is essential to seek medical attention promptly if symptoms worsen or do not improve with treatment, as this may indicate a more severe infection requiring more aggressive treatment 1.

From the Research

Antibiotic Treatment for Ingrown Toenail

There is limited information on the use of antibiotics for ingrown toenails. However, some studies suggest that:

• Oral antibiotics before or after phenolization do not improve outcomes 2
• Topical or oral antibiotics may be used in patients with mild stage 1 disease, but there is no consensus on the best antibiotic to use 3

Alternative Treatments

Some alternative treatments for ingrown toenails include:

• Soaking the foot in warm, soapy water 2, 3
• Placing cotton wisps or dental floss under the ingrown nail edge 4, 2
• Gutter splinting with or without the placement of an acrylic nail 2
• Partial nail avulsion or complete nail excision with or without phenolization 2, 3
• Electrocautery, radiofrequency, and carbon dioxide laser ablation of the nail matrix 2, 3

Surgical Approaches

Surgical approaches for ingrown toenails include:

• Partial avulsion of the lateral edge of the nail plate 4
• Matrixectomy, which can be performed through surgical, chemical, or electrosurgical means 4, 3
• Chemical matricectomy with phenol, which is effective but may have a slightly increased risk of postoperative infection 2
• Electrosurgical matricectomy, which may offer more controlled tissue destruction and less postoperative drainage 3