From the Research
For a paronychia of the toe, the best antibiotic treatment is typically oral cephalexin 500 mg four times daily for 7-10 days, as it targets Staphylococcus aureus and Streptococcus species, which are the most common bacterial causes of paronychia, as supported by 1. Before starting antibiotics, it's essential to drain any abscess if present, as antibiotics alone may not be sufficient without drainage, as noted in 2. For mild cases, topical antibiotics like mupirocin 2% ointment applied three times daily may be adequate. If MRSA is suspected based on local prevalence or patient risk factors, consider clindamycin 300-450 mg four times daily or trimethoprim-sulfamethoxazole (one double-strength tablet twice daily), as suggested by 1. Some key points to consider in the treatment of paronychia include:
- Draining any abscess if present, as antibiotics alone may not be sufficient without drainage
- Using topical antibiotics like mupirocin 2% ointment for mild cases
- Considering clindamycin or trimethoprim-sulfamethoxazole if MRSA is suspected
- Keeping the affected area clean and dry, avoiding trauma to the nail, and elevating the foot when possible to reduce swelling, as mentioned in 2. Warm soaks for 15 minutes 3-4 times daily can help reduce inflammation and pain. If symptoms don't improve within 48-72 hours of treatment, reevaluation is necessary to consider alternative diagnoses or resistant organisms. It's also important to note that the procedure for treating paronychia is selected based on the stage of infection, with careful removal of the focal infection in the area of the nail fold, as described in 2.