Treatment of acute paronychia

MSSA: methicillin-sensitive Staphylococcus aureus; MRSA: methicillin-resistant Staphylococcus aureus.
* Empiric oral antibiotic therapy is offered to immunosuppressed patients while awaiting results of the culture.
¶ Topical antibiotic ointments:

• Triple antibiotic (bacitracin-neomycin-polymyxin B) or
• Mupirocin 2%

Δ Oral antibiotic therapy adult dosing:

• Dicloxacillin 250 to 500 mg 4 times daily
• Cephalexin 500 mg 4 times daily
• Trimethoprim-sulfamethoxazole 1 to 2 double-strength tablets twice daily
• Doxycycline 100 mg twice daily
• Amoxicillin-clavulanate 875/125 mg twice daily
• Doxycycline 100 mg twice daily plus metronidazole 500 mg 3 times daily

Usual duration of therapy is 5 days. Therapy may be extended to up to 14 days in immunosuppressed patients. Some patients may require dose adjustment for kidney impairment.