From the Guidelines
Antibiotics should only be prescribed for ingrown toenails when there is clear evidence of infection, and the choice of antibiotic should be based on the likely causative pathogen, clinical severity, and patient-related factors. When prescribing antibiotics, it is essential to consider the potential harms, including adverse effects, antibiotic resistance, and unnecessary treatment 1. For mild infections, topical antibiotics like mupirocin (Bactroban) applied three times daily may be sufficient, while for more severe infections, oral antibiotics such as cephalexin (Keflex) 500mg four times daily for 7-10 days or clindamycin 300mg four times daily for 7-10 days may be necessary 1.
Key Considerations
- The decision to prescribe antibiotics should be based on the presence of signs of infection, such as redness, swelling, warmth, pain, or pus.
- The choice of antibiotic should be guided by the likely causative pathogen, clinical severity, and patient-related factors, such as allergies and comorbidities 1.
- Topical antibiotics may be sufficient for mild infections, while oral antibiotics may be necessary for more severe infections.
- Antibiotics alone will not resolve the underlying problem, and proper management of the ingrown nail is essential, including warm soaks, keeping the area clean and dry, and gently lifting the nail edge 1.
Management of Ingrown Toenails
- Warm soaks 2-3 times daily to reduce pain and swelling.
- Keeping the area clean and dry to prevent infection.
- Wearing open-toed shoes or sandals if possible to reduce pressure on the toe.
- Gently lifting the nail edge with clean cotton to help the nail grow out properly.
- Professional treatment may be necessary if symptoms persist or worsen despite antibiotics, which may include partial or complete nail removal 1.
From the Research
Antibiotic Treatment for Ingrown Toenail
- There is no mention of antibiotic treatment as a primary treatment for ingrown toenails in the provided studies 2, 3, 4, 5.
- However, one study investigated the use of prophyltic antibiotics in ingrown toenail surgery and found that it did not reduce postoperative morbidity 6.
- The studies suggest that surgical techniques such as phenolisation of the lateral matrix horn 2, marginal nail elevation combined with surgical excision of the granulation tissue 3, and electrocautery matrixectomy 6 are effective in treating ingrown toenails.
- Non-surgical methods such as nail splinting by flexible tube 4 and segmental phenolic ablation 5 are also mentioned as effective treatments for ingrown toenails.
Surgical Techniques
- Phenolisation of the lateral matrix horn is considered the safest, simplest, and most commonly performed method with the lowest recurrence rate 2.
- Marginal nail elevation combined with surgical excision of the granulation tissue has been shown to be successful with low recurrence and failure rates 3.
- Electrocautery matrixectomy has been found to decrease recurrence rates when added to the Winograd technique 6.