What is the appropriate antibiotic choice for an ingrown toenail with signs of infection?

From the Guidelines

For an infected ingrown toenail, the first-line antibiotic treatment is typically oral cephalexin (Keflex) 500 mg four times daily for 7-10 days, as it targets the most common causative organisms, which are Staphylococcus aureus and Streptococcus species 1.

Key Considerations

• The choice of antibiotic should be based on the likely causative pathogen, clinical severity of the infection, and patient-related factors such as history of drug allergies and comorbidities 1.
• For mild infections, gram-positive pathogens such as beta-haemolytic streptococci and S. aureus are the most likely causative organisms, and antibiotics such as cephalexin or dicloxacillin are suitable options 1.
• In cases where MRSA is suspected, trimethoprim-sulfamethoxazole (Bactrim) may be considered as an alternative 1.
• It is essential to note that antibiotic therapy should be combined with proper wound care, including warm water soaks, proper nail trimming technique, and keeping the area clean and dry.

Additional Recommendations

• For severe infections or if there's no improvement after 48-72 hours of antibiotic therapy, the patient should be evaluated for possible partial nail removal (partial onychectomy) 1.
• Patients with diabetes, peripheral vascular disease, or immunocompromised states should be treated more aggressively and may require earlier surgical intervention 1.
• The duration of antibiotic therapy should be based on the clinical response, and treatment should be adjusted if cultures reveal resistant organisms or those that are not gram-positive cocci 1.

From the Research

Antibiotic Choice for Ingrown Toenail

• The choice of antibiotic for an ingrown toenail with signs of infection is crucial, but there is limited evidence to support the use of antibiotics in this condition 2, 3.
• A study published in 2000 found that the use of oral antibiotics as an adjunctive therapy in treating ingrown toenails does not play a role in decreasing the healing time or postprocedure morbidity 2.
• Another study published in 2007 found that local antibiotics did not reduce signs of infection or recurrence after partial nail avulsion with phenolization or matrix excision 3.
• However, for skin and soft tissue infections, including those caused by Staphylococcus aureus, antibiotics such as cephalexin, clindamycin, and erythromycin may be effective 4, 5.
• It is essential to note that the use of antibiotics should be based on the severity of the infection and the presence of other underlying conditions, such as methicillin-resistant Staphylococcus aureus (MRSA) 4.
• In general, antibiotics should be used judiciously and only when necessary to avoid the development of antibiotic resistance.

Considerations for Antibiotic Use

• The choice of antibiotic should be based on the suspected causative organism and local resistance patterns 4.
• For less serious infections, such as skin and soft tissue infections, oral antibiotics such as cephalexin, clindamycin, or erythromycin may be effective 4, 5.
• For more severe infections, such as those caused by MRSA, parenteral vancomycin or other antibiotics may be necessary 4.
• It is crucial to follow local guidelines and consult with a healthcare professional to determine the best course of treatment for an ingrown toenail with signs of infection.

Alternative Treatments

• For ingrown toenails, alternative treatments such as partial nail avulsion, matrix excision, or phenolization may be effective in reducing symptoms and preventing recurrence 6, 3.
• These treatments may be used alone or in combination with antibiotics, depending on the severity of the infection and the presence of other underlying conditions.