Treatment of Infected Ingrown Toenails with Cephalexin
For infected ingrown toenails, cephalexin 500mg four times daily for 7-10 days is the recommended first-line antibiotic treatment, effective against the common causative organisms Staphylococcus aureus and Streptococcus species. 1, 2
Antibiotic Selection and Dosing
- Cephalexin 500mg four times daily for 7-10 days is the first-line antibiotic treatment for infected ingrown toenails 1
- Cephalexin is specifically indicated for skin and skin structure infections caused by Staphylococcus aureus and Streptococcus pyogenes, which are the common pathogens in infected ingrown toenails 2
- For mild to moderate infections without systemic signs, a 5-day course may be sufficient if clinical improvement occurs 3
- If no improvement is seen within 5 days, treatment should be extended 3
Assessment of Infection Severity
- Evaluate for purulent discharge, erythema, warmth, and pain to confirm bacterial infection requiring antibiotics 1
- Determine if there are systemic signs of infection (fever, elevated white blood cell count) which may require more aggressive treatment 3
- Culture of the wound is not routinely recommended for typical cases of infected ingrown toenails 3
- Consider cultures in patients with diabetes, immunocompromised status, or recurrent infections 3
Alternative Antibiotic Options
- For patients with penicillin allergy, clindamycin 300-450mg four times daily orally is an alternative 3
- Amoxicillin-clavulanate 875/125mg twice daily for 7-10 days provides broader coverage if anaerobes are suspected 1
- If MRSA is suspected (based on prior history, failed treatment, or local prevalence), consider trimethoprim-sulfamethoxazole or doxycycline 3
Adjunctive Measures
- Warm soaks with dilute povidone-iodine solution twice daily help reduce bacterial load and inflammation 1
- Partial removal of the ingrown portion of the nail is often necessary alongside antibiotic therapy 4, 5
- Elevation of the affected foot helps reduce edema and improve healing 3
- Place cotton wisps or dental floss under the ingrown nail edge to separate it from the lateral fold 4, 5
Follow-up and Surgical Considerations
- Re-evaluate after 2-3 days of antibiotic therapy to ensure improvement 1
- If no improvement occurs after 48-72 hours of appropriate antibiotic therapy, consider surgical intervention 1
- Partial nail avulsion with or without phenolization may be necessary for recurrent or severe cases 4, 5
- Teach proper nail trimming techniques to prevent recurrence - straight across, not curved 6
Special Considerations
- For diabetic patients with infected ingrown toenails, more aggressive treatment and closer follow-up may be required 3
- Consider broader spectrum antibiotics for diabetic patients with moderate to severe infections 3
- Surgical approaches are superior to nonsurgical ones for preventing recurrence in chronic cases 4