From the Guidelines
For the treatment of paronychia, topical antibiotics such as povidone iodine 2% or topical antibiotics/corticosteroids are recommended for grade 1 treatment, while oral antibiotics may be necessary for grade 2 treatment or higher, as indicated by the most recent guidelines 1. When considering the management of paronychia, it's essential to assess the severity of the infection, which can be graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
- For grade 1 treatment, where there is nail fold oedema or erythema, disruption of the cuticle, topical povidone iodine 2% or topical antibiotics/corticosteroids are recommended, with reassessment after 2 weeks 1.
- For grade 2 treatment, where there is nail fold oedema or erythema with pain, associated with discharge or nail plate separation, limiting instrumental activities of daily living (ADLs), topical povidone iodine 2%/topical beta-blocking agents/topical antibiotics and corticosteroids and/or oral antibiotics may be necessary, with reassessment after 2 weeks 1.
- In cases of grade 3 (or intolerable grade 2) treatment, where there are limiting self-care ADLs, surgical intervention or antibiotics indicated, and consideration of partial nail avulsion may be necessary, alongside topical povidone iodine 2%/topical beta-blocking agents/topical antibiotics and corticosteroids and/or oral antibiotics 1. It's crucial to note that secondary bacterial or mycological superinfections are present in up to 25% of paronychia cases, and both gram-positive and gram-negative organisms have been implicated, which guides the choice of antibiotics 1. Proper management, including gentle skin care, avoidance of trauma, and the use of antimicrobial soaps, can help prevent the progression of paronychia and reduce the risk of superinfection 1.
From the Research
Recommended Antibiotics for Paronychia
The following antibiotics are recommended for the treatment of paronychia:
- Amoxicillin/clavulanate 2
- Clindamycin 2, 3, 4
- Minocycline 3, 4
- Doxycycline 3, 4
- Trimethoprim/sulfamethoxazole 3, 4
- Dicloxacillin 4
- Cephalexin 4
- Macrolides 4
Considerations for Antibiotic Selection
When selecting an antibiotic for paronychia, consider the following:
- The most common pathogen is Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA) 2, 3, 5, 4
- Mixed anaerobic and aerobic infections may occur, especially in children with oral soothing habits 2
- Antibiotic resistance patterns, such as MRSA, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus 4