From the Guidelines
For an ingrown toenail infection, the most effective antibiotic treatment is typically a broad-spectrum antibiotic such as cephalexin or amoxicillin-clavulanate, as these have been shown to be effective in treating soft tissue infections of the foot, including those caused by gram-positive pathogens like Staphylococcus aureus and Streptococcus species 1. When selecting an antibiotic, it's essential to consider the likely causative pathogen, clinical severity of the infection, and patient-related factors such as allergies and comorbidities.
- The choice of antibiotic should be based on the principles of antibiotic stewardship, including starting with empiric treatment with the narrowest spectrum, shortest duration, fewest adverse effects, safest, and least expensive route 1.
- In cases of mild infections, oral antibiotics like cephalexin (500 mg four times daily for 7-10 days) or amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) are recommended first-line treatments, as they target the common bacteria that cause these infections 1.
- Clindamycin (300 mg four times daily) is an alternative for those with penicillin allergies, but its use should be considered carefully due to the risk of adverse effects and the potential for promoting antibiotic resistance 1.
- It's crucial to note that antibiotics alone are not sufficient treatment for an ingrown toenail infection, and adjunctive measures such as soaking the affected foot in warm water, keeping the area clean and dry, and wearing open-toed shoes or sandals to reduce pressure are also necessary.
- In many cases, partial removal of the ingrown portion of the nail may be necessary to fully resolve the infection and prevent recurrence, and patients should be advised to see a healthcare provider for proper diagnosis and treatment, especially if the infection is severe or if they have diabetes or circulation problems 1.
From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylocci Serious skin and soft tissue infections Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin
The best antibiotic for an ingrown toenail infection is not explicitly stated in the label, but clindamycin may be considered for serious skin and soft tissue infections. However, it is crucial to perform bacteriologic studies to determine the causative organisms and their susceptibility to clindamycin before initiating treatment 2.
- Key considerations:
- The infection should be caused by susceptible bacteria
- Less toxic alternatives should be considered before selecting clindamycin
- Bacteriologic studies should be performed to guide therapy
From the Research
Ingrown Toenail Infection Treatment
- The treatment of ingrown toenail infections often involves a combination of surgical and nonsurgical approaches 3, 4.
- However, 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 5.
Antibiotic Treatment
- There is no consensus on the best antibiotic treatment for ingrown toenail infections, but current choices for antibiotic treatment include novel fluoroquinolones, new combinations of β-lactams/β-lactamase inhibitors, and cefiderocol 6.
- Antibiotic prophylaxis in nail surgery is not clearly established, and there is scant scientific evidence regarding the need for its use in preventing surgical site infection, hematogenous total joint infection, and infective endocarditis 7.
Specific Recommendations
- In non-risk patients with onychocryptosis stage II or III, phenol technique can be used without the need for antibiotics 7.
- In stages IV and V, specific antibiotic treatment should be administered before surgery together with partial ablation of nail until the infection is resolved and the process remits to stage II or III 7.
- The need for prophylaxis for bacterial endocarditis should be considered in high-risk cardiac patients with infective onychocryptosis 7.