What are the recommended topical antibiotics for paronychia (infection of the nail fold)?

From the FDA Drug Label

CLINICAL STUDIES The efficacy of topical mupirocin ointment in impetigo was tested in two studies. DOSAGE AND ADMINISTRATION A small amount of mupirocin ointment should be applied to the affected area three times daily.

The recommended topical antibiotic for paronychia is not explicitly stated in the provided drug labels. However, mupirocin is mentioned as a topical antibiotic for impetigo.

• Key points:
  • Mupirocin ointment is applied to the affected area three times daily.
  • The area treated may be covered with a gauze dressing if desired. Since paronychia is not directly mentioned in the labels, no conclusion can be drawn about its use for this specific condition 1 1.

From the Research

For paronychia, the most effective topical antibiotic is mupirocin 2% ointment applied three times daily for 7-10 days, as it has been shown to be highly effective against Staphylococcus aureus and Streptococcus species, the most common causative bacteria of paronychia 2. The treatment of paronychia involves keeping the affected area clean and dry, avoiding trauma to the nail fold, and applying topical antibiotics.

• Mupirocin 2% ointment is a highly effective option, with studies showing its efficacy in treating primary and secondary skin infections, including those caused by Staphylococcus aureus and Streptococcus species 2, 3.
• Other options include bacitracin ointment and clindamycin 1% solution or cream, which can be applied 2-3 times daily.
• For mild cases, antiseptic soaks with warm water and povidone-iodine solution for 15 minutes, 3-4 times daily can be beneficial before antibiotic application.
• It is essential to note that if the paronychia is severe, shows signs of spreading infection, or doesn't improve within 48-72 hours, oral antibiotics or incision and drainage may be necessary, especially in patients with diabetes or immunocompromised conditions 4. The most recent and highest quality study on the treatment of paronychia recommends the use of topical antibiotics, such as mupirocin 2% ointment, as the first line of treatment 5.
• This study highlights the importance of keeping the affected area clean and dry, and avoiding trauma to the nail fold, in addition to applying topical antibiotics.
• The study also notes that oral antibiotics or incision and drainage may be necessary in severe cases, and that patients with diabetes or immunocompromised conditions should seek medical attention promptly.