Antibiotic Therapy for Infected Ingrown Toenail
Oral antibiotics are indicated when an ingrown toenail is accompanied by cellulitis. [1]
When infection is purulent, incision and drainage is indicated. [1]
Antibiotics for Nonpurulent Cellulitis
For nonpurulent cellulitis, antibiotics should be active against streptococci. [1]
Oral options include: [2]
- Cephalosporins (eg, cephalexin). [2]
- Clindamycin. [2]
- Dicloxacillin. [2]
- Penicillin. [2]
Antibiotics for Purulent Infection (Staphylococcal/MRSA Coverage)
For purulent skin and soft-tissue infection, incision and drainage is indicated. [1]
MRSA coverage (eg, with vancomycin, daptomycin, or linezolid, or oral doxycycline, clindamycin, or TMP-SMX) is considered when MRSA risk is present, including purulent drainage. [1]
If MRSA and streptococci coverage are both desired for oral therapy, options include: [1]
- Clindamycin alone. [1]
- The combination of TMP-SMX with another agent active against streptococci. [1]
Route of Administration
Mild nonpurulent cellulitis is treated with oral antibiotics. [2]
Systemic infection is treated with intravenous antibiotics. [2]
Treatment Decisions Based on Severity
Outpatient therapy is recommended for patients without SIRS, altered mental status, or hemodynamic instability. [1]
Hospitalization is recommended when concern exists for deeper infection or necrotizing infection, for poor adherence, for severe immunocompromise, or for failure of outpatient therapy. [1]
When Antibiotics Are Not Sufficient Without Drainage
Cellulitis management applies to diffuse, superficial spreading skin infection. [1]
When pus is present, management requires incision and drainage rather than antibiotics alone. [1]
Common Pitfalls to Avoid
Delaying treatment while awaiting cultures is not recommended. [2]
In purulent infections, failure to perform incision and drainage when indicated reduces the likelihood of clinical resolution. [1]
Duration and Reassessment
The recommended treatment duration for most cellulitis cases is 5 days. [2]
Treatment duration is extended when improvement does not occur during that timeframe. [2]