What are the first-line antibiotics for paronychia and antibiotics for Methicillin-resistant Staphylococcus aureus (MRSA) infections?

From the Guidelines

For paronychia, the first-line antibiotic treatment is typically dicloxacillin 250-500 mg orally four times daily for 7-10 days, or cephalexin 500 mg orally four times daily for 7-10 days, as recommended by the Infectious Diseases Society of America 1. These antibiotics target the most common causative organisms, which are Staphylococcus aureus and Streptococcus species. If MRSA (Methicillin-resistant Staphylococcus aureus) is suspected or confirmed, appropriate antibiotic options include:

• trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily
• clindamycin 300-450 mg orally four times daily
• doxycycline 100 mg orally twice daily, all for 7-10 days 1. It's essential to note that incision and drainage is a crucial component of treatment for any abscess formation, regardless of antibiotic choice. Warm soaks for 15 minutes 3-4 times daily can help with pain relief and promote drainage. Patients should be advised to keep the affected area clean and dry, avoid nail biting or finger sucking, and return for follow-up if symptoms worsen or don't improve within 48-72 hours of starting treatment. The choice between these antibiotics should consider local resistance patterns, patient allergies, and comorbidities such as renal function. Key considerations for treatment include:
• The severity of the infection
• The presence of systemic symptoms
• The patient's underlying health conditions
• The potential for antibiotic resistance as outlined in the guidelines for the treatment of skin and soft tissue infections 1.

From the FDA Drug Label

The cure rates by pathogen for microbiologically evaluable patients are presented in Table 18. Table 18 Cure Rates at the Test-of-Cure Visit for Microbiologically Evaluable Adult Patients with Complicated Skin and Skin Structure Infections Pathogen Cured ZYVOX n/N (%) Oxacillin/Dicloxacillin n/N (%) Staphylococcus aureus 73/83 (88) 72/84 (86) Methicillin-resistant S aureus 2/3 (67) 0/0 (-) Streptococcus agalactiae 6/6 (100) 3/6 (50) Streptococcus pyogenes 18/26 (69) 21/28 (75)

For Paronychia, which is a type of skin infection, the first line antibiotics are not explicitly stated in the provided drug labels. However, based on the information provided for complicated skin and skin structure infections, the cure rates for Staphylococcus aureus and Methicillin-resistant S aureus are presented.

• Staphylococcus aureus had a cure rate of 88% with ZYVOX and 86% with Oxacillin/Dicloxacillin.
• Methicillin-resistant S aureus had a cure rate of 67% with ZYVOX, but there were no patients treated with Oxacillin/Dicloxacillin. For MRSA antibiotics, the provided drug labels mention that ZYVOX had a cure rate of 79% for MRSA skin and skin structure infection, compared to 73% for vancomycin 2.

Key points:

• ZYVOX is effective against Staphylococcus aureus and Methicillin-resistant S aureus.
• The cure rates for ZYVOX are comparable to or better than those for other antibiotics, such as Oxacillin/Dicloxacillin and vancomycin.
• ZYVOX may be a suitable option for the treatment of Paronychia caused by Staphylococcus aureus or Methicillin-resistant S aureus.

From the Research

Paronychia and MRSA Antibiotics

• Paronychia is a type of skin infection that can be caused by bacteria such as Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA) 3, 4.
• For the treatment of uncomplicated skin and skin structure infections, including paronychia, oral antibiotics such as dicloxacillin, cephalexin, and clindamycin can be used for methicillin-susceptible S. aureus (MSSA) infections 3, 4.
• For MRSA infections, oral antibiotics such as clindamycin, doxycycline, minocycline, and trimethoprim-sulfamethoxazole (SXT) can be used 4.
• In cases of paronychia caused by Group A Streptococcus (GAS), amoxicillin has been shown to be effective in treating the infection without the need for surgical procedures 5.
• However, for cases of paronychia caused by Staphylococcus aureus, including MRSA, surgery may be required in some cases 5.

First Line Antibiotics for Paronychia

• The choice of first-line antibiotics for paronychia depends on the suspected causative agent and local susceptibility patterns 3, 4.
• For MSSA infections, penicillinase-resistant penicillins such as flucloxacillin and dicloxacillin can be used as first-line treatment 3.
• For MRSA infections, clindamycin, doxycycline, minocycline, and SXT can be used as first-line treatment 4.

MRSA Antibiotics

• For serious MRSA infections, parenteral vancomycin or teicoplanin can be used as treatment 3.
• For less serious MRSA infections, such as skin and soft tissue infections, oral antibiotics such as clindamycin, doxycycline, minocycline, and SXT can be used 3, 4.
• In cases of multiresistant MRSA, a combination of two oral antimicrobials, such as rifampicin and fusidic acid, may be necessary to prevent the development of resistance 3.