From the Guidelines
A felon, which is a painful infection in the pulp space of the fingertip, requires prompt treatment to prevent complications, and the most effective management includes elevation of the affected hand, warm water soaks, and oral antibiotics that cover Staphylococcus aureus, with surgical drainage necessary if an abscess forms 1.
Initial Management
- Elevation of the affected hand to reduce swelling
- Warm water soaks 3-4 times daily for 15 minutes to promote drainage and comfort
- Oral antibiotics that cover Staphylococcus aureus, such as dicloxacillin 500mg four times daily or cephalexin 500mg four times daily for 7-10 days, as recommended by the Infectious Diseases Society of America 1
Antibiotic Selection
- For patients with penicillin allergies, clindamycin 300-450mg four times daily is appropriate
- Consideration of the local prevalence of MRSA and the severity of the infection when selecting an empiric antibiotic regimen, as outlined in the 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections 1
Surgical Drainage
- Necessary if the infection has progressed to form an abscess
- Involves making a small incision over the point of maximal tenderness, typically on the pad of the fingertip but avoiding the central area to prevent scarring and sensory loss
- After drainage, the wound should be packed with sterile gauze and changed daily until healing occurs
Pain Management
- Pain management with acetaminophen or NSAIDs is recommended
- Patients should seek immediate medical attention if symptoms worsen despite treatment, as untreated felons can lead to osteomyelitis, septic arthritis, or permanent damage to the fingertip, highlighting the importance of prompt and effective management 1
From the Research
Management of a Felon in Finger
There are no research papers to assist in answering this question. The provided studies 2, 3, 4, 5 focus on antibiotic prescribing, spectrum, and potency, as well as the risks associated with specific antibiotic courses, but do not address the management of a felon in finger.
- The studies discuss various antibiotics, including amoxicillin, cephalexin, and cephalosporins, and their uses in treating infections 2, 3, 4.
- They also examine the risks of Clostridioides difficile infection associated with specific antibiotic courses 5.
- However, none of the studies provide information on the management of a felon in finger, which is a type of abscess that occurs on the fingertip.