What antibiotics are used to treat an ingrown toenail (onychocryptosis)?

From the Guidelines

Antibiotics should only be prescribed for ingrown toenails when there is clear evidence of infection, and the choice of antibiotic should be guided by the severity of the infection and the presence of systemic inflammatory response syndrome (SIRS) 1.

Key Considerations

• The decision to administer antibiotics should be based on the presence or absence of systemic inflammatory response syndrome (SIRS), such as temperature >38°C or <36°C, tachypnea >24 breaths per minute, tachycardia >90 beats per minute, or white blood cell count >12 000 or <400 cells/µL 1.
• For mild infections without SIRS, topical antibiotics like mupirocin (Bactroban) or bacitracin applied three times daily may be sufficient 1.
• For more severe infections or those with SIRS, oral antibiotics such as cephalexin (Keflex) 500mg four times daily, dicloxacillin 500mg four times daily, or clindamycin 300mg four times daily for 7-10 days may be prescribed 1.

Treatment Approach

• The definitive treatment for ingrown toenails involves proper nail care and possibly a minor procedure to remove the ingrown portion of the nail.
• While waiting for medical care, patients can soak the foot in warm water with Epsom salt for 15-20 minutes several times daily, keep the area clean and dry, wear open-toed shoes or sandals to reduce pressure, and take over-the-counter pain relievers if needed.

Antibiotic Selection

• The choice of antibiotic should be guided by the severity of the infection and the presence of SIRS, as well as the potential for methicillin-resistant Staphylococcus aureus (MRSA) 1.
• For patients with carbuncles or abscesses who have failed initial antibiotic treatment or have markedly impaired host defenses or SIRS and hypotension, an antibiotic active against MRSA, such as vancomycin or linezolid, may be recommended 1.

From the Research

Antibiotics for Ingrown Toenail

• The use of antibiotics in the treatment of ingrown toenails is a topic of discussion, with some studies suggesting that they may not be necessary in all cases 2.
• A study published in 2000 found that the use of oral antibiotics as an adjunctive therapy in treating ingrown toenails does not play a role in decreasing the healing time or postprocedure morbidity 2.
• Another study published in 2009 found that oral antibiotics before or after phenolization do not improve outcomes in the treatment of ingrown toenails 3.
• However, some studies suggest that antibiotics may be necessary in cases where the ingrown toenail is infected, but the evidence is not conclusive 4.
• The management of ingrown toenails can be divided into conservative and surgical approaches, with antibiotics being used in some cases to treat infection 5, 6.

Treatment Approaches

• Conservative treatment approaches include soaking the foot in warm water, use of topical antibiotics, and proper nail-trimming technique 4.
• Surgical approaches include partial nail avulsion, lateral matricectomy, and destruction of the lateral wall granulation tissue 4.
• Chemical matricectomy with phenol is effective, but electrosurgical matricectomy may offer more controlled tissue destruction and less postoperative drainage 4.
• The choice of treatment approach depends on the severity of the ingrown toenail and the presence of infection 5, 6.

Prevention

• Prevention of ingrown toenails is important, and can be achieved through proper nail-trimming technique, wearing shoes that fit properly, and avoiding trauma to the toe 3, 5, 6.
• Keeping the feet clean and dry can also help to prevent ingrown toenails 5, 6.