What medication is used to treat an ingrown toenail infection?

Treatment of Ingrown Toenail Infection

For ingrown toenail infections, oral antibiotics such as amoxicillin-clavulanate are the first-line treatment, combined with antiseptic soaks using povidone-iodine or dilute vinegar solutions. 1, 2

Initial Management of Infected Ingrown Toenails

• Antiseptic soaks are essential first-line treatment - options include:

  • Daily dilute vinegar soaks (50:50 dilution) to nail folds twice daily for 10-15 minutes 2
  • 2% povidone-iodine soaks 2
  • Epsom salt soaks, possibly combined with pHisoHex or Betadine 3

• For active infection with pus or cellulitis:

  • Obtain culture of purulent drainage if present 2
  • Oral antibiotics (amoxicillin-clavulanate) are indicated for bacterial infection 1
  • Take antibiotics with food to reduce gastrointestinal upset 1
  • Complete the full course of antibiotics to prevent resistance 1

Topical Treatments for Inflammation

• Mid to high-potency topical steroid ointment applied to nail folds twice daily to reduce inflammation 2
• Combination topical therapy with antibiotics and corticosteroids for recurrent cases 2
• Avoid topical steroids if active infection is present 2

Mechanical Interventions

• Cotton packing or dental floss insertion under the ingrown nail edge to separate it from the underlying tissue 2, 4, 5
• Taping the nail fold away from the nail plate 2
• Gutter splint application to the ingrown nail edge provides immediate pain relief 4
• Splinting using a flexible tube to encapsulate the lateral edge of the nail 2

Management of Granulation Tissue

• For pyogenic granulomas (proud flesh):
  • Silver nitrate application 2
  • Scoop shave removal with hyfrecation 2
  • High-potency topical steroids 2
  • Topical timolol 0.5% gel twice daily under occlusion for persistent cases 2

Surgical Options for Recurrent or Severe Cases

• Partial avulsion of the lateral edge of the nail plate is the most common surgical approach 4, 5
• Chemical matricectomy with phenol after partial nail avulsion is more effective at preventing recurrence than surgical excision alone 5
• Surgical approaches are superior to nonsurgical ones for preventing recurrence 4

Important Considerations and Pitfalls

• Oral antibiotics should only be used to treat bacterial infections, not for prophylaxis 1
• Monitor for diarrhea during antibiotic treatment, which may indicate C. difficile infection 1
• Patients should be aware that amoxicillin-clavulanate contains a penicillin-class drug that can cause allergic reactions 1
• Surgical intervention should be considered if conservative treatment fails to resolve symptoms 6, 5

Prevention of Recurrence

• Correct inappropriate footwear 4
• Manage contributing factors such as hyperhidrosis and onychomycosis 4
• Proper nail trimming techniques to avoid recurrence 4