What is the recommended antibiotic for an infected toe following a broken toenail?

Antibiotic Treatment for Infected Toe After Breaking Toenail

For an infected toe following a broken toenail, amoxicillin-clavulanate is the recommended first-line antibiotic therapy for mild to moderate infections, with clindamycin or cephalexin as appropriate alternatives for patients with penicillin allergies. 1

Assessing Infection Severity

Before selecting an antibiotic, determine the severity of the infection:

• Mild infection: Local inflammation limited to skin/subcutaneous tissue with ≤2 cm erythema
• Moderate infection: Cellulitis >2 cm or deeper tissue involvement
• Severe infection: Systemic toxicity or metabolic instability 1

Antibiotic Recommendations by Severity

Mild Infection (Most Common for Broken Toenail)

• First choice: Amoxicillin-clavulanate 875/125 mg twice daily 1
• Alternatives for penicillin allergy:
  • Clindamycin 300 mg three times daily
  • Cephalexin 500 mg four times daily (if no anaphylactic penicillin allergy) 1
  • Doxycycline 100 mg twice daily 1

Moderate Infection

• Oral options:
  • Amoxicillin-clavulanate 875/125 mg twice daily
  • Levofloxacin 750 mg daily (if risk of gram-negative organisms) 1
• Parenteral options (if oral therapy not appropriate):
  • Ampicillin-sulbactam 1.5-3.0 g every 6 hours
  • Ceftriaxone 1-2 g daily 1

Severe Infection (Requires hospitalization)

• Parenteral therapy:
  • Piperacillin-tazobactam 3.37 g every 6-8 hours
  • Ertapenem 1 g daily
  • Imipenem-cilastatin 1

Special Considerations

MRSA Risk Factors

If MRSA is suspected (previous MRSA infection, recent hospitalization, recent antibiotics):

• Add or substitute:
  • Trimethoprim-sulfamethoxazole 160/800 mg twice daily
  • Linezolid 600 mg twice daily
  • Doxycycline 100 mg twice daily 1

Pseudomonas Risk Factors

If Pseudomonas is suspected (macerated wound, warm climate):

• Consider:
  • Ciprofloxacin 500-750 mg twice daily
  • Piperacillin-tazobactam (for severe infections) 1

Duration of Therapy

• Mild infections: 7-10 days
• Moderate infections: 10-14 days
• Severe infections: 2-3 weeks 1

Adjunctive Measures

Antibiotic therapy alone is often insufficient. Always include:

1. Wound care: Proper cleansing and debridement of necrotic tissue 1
2. Pressure offloading: Crucial for healing - avoid weight-bearing on the affected toe 2
3. Tetanus prophylaxis: Administer tetanus toxoid if vaccination not current within 10 years 1

Follow-up Recommendations

• Re-evaluate in 2-3 days for infected wounds
• Monitor for decreasing erythema, reduction in exudate, and resolution of pain 2
• Consider culture-directed therapy if no improvement after 48-72 hours 1

Common Pitfalls to Avoid

• Pitfall #1: Using antibiotics for uninfected wounds - antibiotics do not enhance healing of uninfected wounds and promote antimicrobial resistance 2
• Pitfall #2: Failing to debride necrotic tissue - proper wound care is essential for antibiotic effectiveness 1
• Pitfall #3: Inadequate spectrum coverage - consider recent antibiotic exposure when selecting empiric therapy 1
• Pitfall #4: Continuing antibiotics until complete wound healing - antibiotics should be discontinued once infection resolves, even if the wound hasn't fully healed 1

Remember that the most recent guidelines emphasize that antibiotic therapy is necessary for virtually all infected wounds, but it is often insufficient without appropriate wound care 1, 2.