Antibiotic Treatment for Paronychia

Introduction to Paronychia Treatment

The American College of Physicians recommends dicloxacillin (250 mg 4 times daily) or cephalexin (250 mg 4 times daily) as first-line antibiotics for acute bacterial paronychia, targeting Staphylococcus aureus 1
For penicillin-allergic patients, clindamycin (300-400 mg 3 times daily) is recommended 1
For suspected MRSA infection, trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily) or doxycycline (100 mg twice daily) can be used 1

Topical steroids (mid to high potency) are preferred to reduce inflammation in chronic paronychia 2
Topical povidone iodine 2% twice daily has shown benefit in controlled studies for chronic paronychia 3
If fungal infection with Candida is confirmed, itraconazole should be considered first-line treatment, with fluconazole as an alternative 4

Culture-guided therapy should be considered in cases of treatment failure, with adjustment of antibiotic therapy based on culture results and sensitivity patterns 3, 5
Antiseptic soaks with dilute vinegar or 2% povidone-iodine, and avoidance of repeated trauma to the nail unit, are recommended as adjunctive measures 2
Failure to recognize drug-induced paronychia, particularly from EGFR inhibitors in cancer patients, can lead to inappropriate management, and requires different treatment approaches 3, 5, 6