From the Guidelines
For paronychia, the recommended antibiotics are dicloxacillin, cephalexin, or clindamycin, with amoxicillin-clavulanate as an alternative, based on the most recent guidelines from the Infectious Diseases Society of America and the WHO Model List of Essential Medicines 1.
Key Considerations
- The choice of antibiotic depends on the severity of the infection and the suspected causative pathogens, which are often Staphylococcus aureus and Streptococcus species.
- Before starting antibiotics, warm water soaks and drainage of pus, if present, should be considered as initial management steps.
- Mild infections may resolve with these non-antibiotic measures alone, but antibiotics are necessary for moderate to severe infections or when there are signs of spreading infection.
Recommended Antibiotics
- Dicloxacillin 500mg four times daily for 7-10 days is a common prescription for moderate to severe infections.
- Alternatives include:
- Cephalexin 500mg four times daily.
- Clindamycin 300mg four times daily.
- Amoxicillin-clavulanate 875/125mg twice daily for the same duration.
Important Notes
- If symptoms worsen despite treatment, or if the patient has diabetes or is immunocompromised, medical attention should be sought promptly as more aggressive treatment may be needed.
- Prevention strategies include avoiding nail biting, trauma to nails, and excessive moisture exposure.
- The Infectious Diseases Society of America guidelines and the WHO Model List of Essential Medicines provide the foundation for these recommendations, emphasizing the importance of appropriate antibiotic use to balance efficacy with the risk of resistance and side effects 1.
From the FDA Drug Label
The penicillinase-resistant penicillins are available for oral administration and for intramuscular and intravenous injection. Bacteriologic studies to determine the causative organisms and their sensitivity to the penicillinase-resistant penicillins should always be performed.
The recommended antibiotic for paronychia (infection of the fingernail) is a penicillinase-resistant penicillin, such as dicloxacillin.
- The dosage of dicloxacillin for mild to moderate infections is 125 mg every 6 hours for adults, and 12.5 mg/kg/day in equally divided doses every 6 hours for children weighing less than 40 kg (88 lbs.) 2.
- The duration of therapy varies with the type and severity of infection, and should be determined by the clinical and bacteriological response of the patient.
- Bacteriologic studies should be performed to determine the causative organisms and their sensitivity to the penicillinase-resistant penicillins.
From the Research
Treatment Options for Paronychia
- The recommended treatment for acute paronychia includes warm compresses, topical antibiotics, with or without corticosteroids, oral antibiotics, or surgical incision and drainage for more severe cases 3, 4, 5.
- Topical antibiotics should be used with or without topical steroids when simple soaks do not relieve the inflammation 5.
- The presence of an abscess should be determined, which mandates drainage 5.
- Oral antibiotics are usually not needed if adequate drainage is achieved unless the patient is immunocompromised or a severe infection is present 5.
- Therapy is based on the most likely pathogens and local resistance patterns 5.
Chronic Paronychia Treatment
- Chronic paronychia is characterized by symptoms of at least six weeks' duration and represents an irritant dermatitis to the breached nail barrier 5.
- Treatment is aimed at stopping the source of irritation while treating the inflammation with topical steroids or calcineurin inhibitors 5.
- More aggressive techniques may be required to restore the protective nail barrier 5.
- Treatment may take weeks to months 5.
- Patient education is paramount to reduce the recurrence of acute and chronic paronychia 5.
Antibiotic Treatment
- There is no specific mention of recommended antibiotics for paronychia in the provided studies, however, it is mentioned that therapy is based on the most likely pathogens and local resistance patterns 5.