From the FDA Drug Label
DOSAGE AND ADMINISTRATION 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 best antibiotic for paronychia (infection of the nail fold) is not explicitly stated in the provided drug labels. However, based on the information provided, dicloxacillin 1 may be considered for the treatment of skin and soft tissue infections caused by susceptible strains of staphylococci.
- Key points:
- Dicloxacillin is a penicillinase-resistant penicillin.
- It is effective against staphylococcal infections.
- Bacteriologic studies should be performed to determine the causative organisms and their sensitivity to dicloxacillin. Alternatively, clindamycin 2 may also be considered for the treatment of serious skin and soft tissue infections caused by susceptible strains of staphylococci, especially in patients who are allergic to penicillin.
- Key points:
- Clindamycin is effective against staphylococcal infections.
- It should be reserved for penicillin-allergic patients or other patients for whom a penicillin is inappropriate.
- Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin.
From the Research
For paronychia, the best approach is often not antibiotics, but rather surgical excision of the abscess, if present, and supportive care such as warm soaks, as evidenced by a prospective study of 46 patients where none received postoperative antibiotics and had excellent results with only rare recurrence 3. When considering antibiotic therapy, it's crucial to differentiate between acute and chronic paronychia, as well as to identify potential causative pathogens.
- Acute paronychia is commonly caused by Staphylococcus aureus and Streptococcus species.
- Chronic paronychia may involve fungal infections, particularly Candida species, and thus may require antifungal treatment. Given the potential for antibiotic resistance, especially with MRSA, the choice of antibiotic should be guided by local resistance patterns and patient-specific risk factors.
- For patients with penicillin allergies, alternatives such as cephalexin or clindamycin may be considered.
- If MRSA is suspected, trimethoprim-sulfamethoxazole or doxycycline could be more appropriate, as suggested by studies on antibiotic-resistant infections 4, 5. However, the most recent and highest quality evidence suggests that, in many cases, especially uncomplicated ones, antibiotics may not be necessary after surgical treatment, emphasizing the importance of proper surgical excision and supportive care 3. It's also worth noting that not all paronychia cases are due to bacterial infections; viral, fungal, and non-infectious causes should also be considered, as highlighted in a study on antibiotic-resistant acute paronychia 6. Ultimately, the management of paronychia should be tailored to the individual case, considering the severity of the infection, the presence of any complicating factors, and the potential for antibiotic resistance.