What antibiotics are used to treat paronychia?

Antibiotic Treatment for Paronychia

For acute bacterial paronychia, topical antibiotics with steroids are recommended as first-line treatment, with oral antibiotics reserved for severe cases or when an abscess is present requiring drainage. 1

Classification and Initial Assessment

• Acute paronychia: Typically bacterial (polymicrobial) infection after nail barrier breach
• Chronic paronychia: Inflammation lasting ≥6 weeks, representing irritant dermatitis

Treatment Algorithm for Bacterial Paronychia

First-Line Treatment

1. Conservative measures:

   • Warm soaks with antiseptic solution (10-15 minutes, 2-3 times daily) 2
   • Dilute vinegar soaks (50:50 dilution) to nail folds twice daily 1

2. Topical therapy:

   • Topical antibiotics combined with steroids for inflammation 1
   • Mid to high-potency topical corticosteroid ointment for inflammation 1

3. Surgical drainage is mandatory if an abscess is present 1

Oral Antibiotics (for severe cases only)

• Oral antibiotics are usually not needed if adequate drainage is achieved unless:

  • Patient is immunocompromised
  • Severe infection is present
  • Infection is spreading 2

• Recommended oral antibiotics (based on common pathogens):

  • Cephalosporins
  • Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) 3

Treatment for Fungal Paronychia

• Topical antifungals: Imidazoles for fungal involvement 1
• Oral antifungals:
  • Fluconazole for Candida species 1
  • Itraconazole for resistant cases 1

Special Considerations

Diabetic Patients

• Require more vigilant monitoring and earlier intervention
• Keep the area dry to prevent further infection 1

Immunocompromised Patients

• Lower threshold for oral antibiotics
• More aggressive treatment approach 1

Prevention Strategies

• Keep hands dry, avoid prolonged water exposure
• Wear gloves while cleaning or doing wet work
• Apply daily topical emollients to cuticles and periungual tissues 1

Important Caveats

• Do not use systemic antibiotics routinely unless infection is proven 4
• Cytologic examination (Tzanck smear) may be useful to identify the cause of antibiotic-resistant paronychia 5
• Consider non-infectious causes in antibiotic-resistant cases (contact dermatitis, drug reactions, autoimmune conditions) 5
• Regular follow-up every 2-4 weeks until resolution is recommended 1

Remember that paronychia is often polymicrobial, and treatment should target the most likely pathogens based on clinical presentation and local resistance patterns.