From the Research
For an ingrown toenail with infection, the antibiotic of choice is typically oral cephalexin (Keflex) 500 mg four times daily for 7-10 days, as recommended by the most recent and highest quality study 1. This recommendation is based on the fact that cephalexin is effective against the most common causative organisms, including Staphylococcus aureus and streptococci.
- Alternatives to cephalexin include clindamycin 300 mg four times daily, amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily, or trimethoprim-sulfamethoxazole (Bactrim) DS twice daily for the same duration, as supported by studies 2, 3, 4.
- However, antibiotics alone are not sufficient treatment, and the definitive management requires addressing the ingrown nail itself through partial or complete nail removal, often performed by a podiatrist or primary care physician.
- While waiting for professional care, warm water soaks three to four times daily, elevation of the affected foot, and proper-fitting footwear can help reduce inflammation.
- Topical antibiotics like mupirocin or bacitracin may be used for very mild cases, but are generally insufficient for moderate to severe infections, as noted in study 1.
- If there is significant cellulitis, purulent drainage, or the patient has diabetes or is immunocompromised, more aggressive treatment and follow-up are necessary, as emphasized in study 4.