Management of Paronychia Worsening with Cephalexin

Rationale for Antibiotic Switch

• The Infectious Diseases Society of America recommends switching to sulfamethoxazole-trimethoprim, such as Bactrim, for skin and soft tissue infections, particularly when MRSA is suspected, as it provides broader coverage than cephalexin 1
• Secondary bacterial or mycological superinfections are present in up to 25% of paronychia cases, which may not respond to cephalexin 3, 4

Assessment Before Switching

• Obtain bacterial, viral, and fungal cultures to identify potential resistant organisms or non-bacterial causes of infection 4
• Evaluate the severity of paronychia based on parameters including redness, edema, discharge, and granulation tissue 3, 5

Treatment Algorithm

• Discontinue cephalexin immediately and start Bactrim (sulfamethoxazole-trimethoprim) as it covers both gram-positive and gram-negative organisms 1, 2
• Apply topical povidone iodine 2% twice daily to the affected area 4, 2

Monitoring and Follow-up

• Reassess after 2 weeks of the new treatment regimen 3, 4
• If no improvement is seen, consider referral to dermatology or hand surgery for further evaluation 2

Prevention of Recurrence

• Implement preventive measures including keeping hands dry and avoiding trauma to nails 4, 2
• Regular application of emollients to periungual tissues 3, 4
• Wear protective gloves during activities involving water or chemicals 4, 2
• Ensure proper nail care: trim nails straight across and not too short 4