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Hand Infections Medication

  • Author: Jordan Scaff, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
Updated: Jan 11, 2016

Medication Summary

The goals of pharmacotherapy are to eradicate the infection and to prevent complications. With the rise of methicillin-resistant Staphylococcus aureus (MRSA) as a cause of hand infections, coverage with appropriate antibiotics is important.[6, 7] In this era, cephalexin alone is inappropriate coverage for hand infections, and coverage for all infections should include MRSA coverage.



Class Summary

Therapy must cover all likely pathogens in the context of the clinical setting.

Cephalexin (Keflex)


First-generation cephalosporin that inhibits bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal and effective against rapidly growing organisms forming cell walls. Primarily active against skin flora. Typically used for skin structure coverage and as prophylaxis in minor procedures. DOC for immunocompromised patients with paronychia.

Clindamycin (Cleocin)


Lincosamide useful as treatment against serious skin and soft tissue infections caused by most staphylococcal strains. Also effective against aerobic and anaerobic streptococci, except enterococci. Inhibits bacterial protein synthesis by inhibiting peptide chain initiation at bacterial ribosome where it preferentially binds to 50S ribosomal subunit, causing bacterial growth inhibition. DOC for paronychia in children and those who wash dishes.

Ampicillin-sulbactam (Unasyn)


Combination antimicrobial agent that uses a beta-lactamase inhibitor with ampicillin. Covers skin, enteric flora, and anaerobes. DOC for infectious tenosynovitis and deep fascial space infections.

Cefazolin (Ancef, Kefzol, Zolicef)


First-generation semisynthetic cephalosporin, which, by binding to 1 or more penicillin-binding proteins, arrests bacterial cell wall synthesis and inhibits bacterial growth. Primarily active against skin flora, including S aureus. Typically used alone for skin and skin-structure coverage. An alternate DOC for infectious tenosynovitis and deep fascial space infections.

Vancomycin (Vancocin)


Potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Useful in treatment of septicemia and skin structure infections. Indicated for patients who cannot receive or whose conditions have not responded to penicillins and cephalosporins or for those who have infections with resistant staphylococci. For abdominal penetrating injuries, combine with agent active against enteric flora and/or anaerobes. DOC (in conjunction with gentamicin) for infectious tenosynovitis and deep fascial space infections in patients who are allergic to penicillin. To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dosing. Use CrCl to adjust dose in patients with renal impairment.

Gentamicin (Garamycin, Gentacidin)


Aminoglycoside antibiotic used for gram-negative bacterial coverage. Used commonly in combination with both an agent against gram-positive organisms and an agent that covers anaerobes. DOC (in conjunction with vancomycin) for infectious tenosynovitis and deep fascial space infections in patients who are allergic to penicillin. Dosing regimens are numerous and are adjusted based on CrCl and changes in volume of distribution.



Class Summary

These agents are used to induce and boost active immunity.

Tetanus toxoid adsorbed or fluid


Used to induce active immunity against tetanus in selected patients. Immunizing agents of choice for most adults and children >7 y are tetanus and diphtheria toxoids. Necessary to administer booster doses to maintain tetanus immunity throughout life.

Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen-containing product.

In children and adults, may administer into deltoid or midlateral thigh muscles. In infants, preferred site of administration is mid thigh laterally.


Topical steroids

Class Summary

These agents are used in the treatment of chronic paronychia. They have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Hydrocortisone topical (CortaGel, Cortaid, Dermacort, Westcort)


An adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.


Topical antifungal

Class Summary

These agents are used in the treatment of chronic paronychia.

Clotrimazole (Lotrimin, Mycelex)


Broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing death of fungal cells. Reevaluate diagnosis if no clinical improvement after 4 wk.

Contributor Information and Disclosures

Jordan Scaff, MD Resident Physician, Department of Emergency Medicine, Mount Sinai Beth Israel

Jordan Scaff, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.


Gregory S Johnston, MD Assistant Professor of Emergency Medicine, Mount Sinai Beth Israel

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Weiss, MD, DTM&H Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Professor, Department of Surgery (Emergency Medicine), Stanford University Medical Center

Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Oncology Association of Practices, Southern Clinical Neurological Society, Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician, Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Palmetto Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, South Carolina Medical Association, Columbia Medical Society, South Carolina College of Emergency Physicians, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Chief Editor for Medscape.

Additional Contributors

Dan Danzl, MD Chair, Professor, Department of Emergency Medicine, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Rohini J Haar, MD Staff Physician, Department of Emergency Medicine, New York University/Bellevue Hospital Center

Rohini J Haar, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Amy K Rontal, MD, and Heatherlee Bailey, MD, to the development and writing of this article.

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A paronychia can progress to a felon if left untreated.
A herpetic whitlow. Image courtesy of Glen Vaughn, MD.
Paronychia incision and drainage.
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