Paronychia in Emergency Medicine Medication

  • Author: Heather Murphy-Lavoie, MD, FAAEM; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Oct 20, 2010
 

Medication Summary

Antibiotics are not necessary if the incision successfully achieves adequate drainage and no cellulitis is present. Most paronychia infections can be managed without antibiotics. Over-the-counter analgesics are usually sufficient. If cellulitis is present, antibiotics are indicated. Although penicillin covers oral flora, it does not cover methicillin-resistant Staphylococcus aureus (MRSA). Trimethoprim and sulfamethoxazole (TMP/SMX), doxycycline, or clindamycin may be considered to cover community-acquired MRSA and anaerobic organisms. Combination therapy with an IV agent that provides antimicrobial activity against staphylococci is used for inpatient therapy. See Hand Infections for a detailed discussion of antibiotics.

Chronic paronychial infections are usually managed with oral antifungals such as ketoconazole, itraconazole, or fluconazole.[21] This is beyond the scope of emergency medicine practice since many of these agents require a prolonged course with monitoring of laboratory tests to avoid complications.

Next

Antibiotics

Class Summary

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

View full drug information

Clindamycin (Cleocin)

 

Semisynthetic antibiotic produced by 7(S)-chloro-substitution of 7(R)-hydroxyl group of parent compound lincomycin. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Widely distributes in the body without penetration of CNS. Protein bound and excreted by the liver and kidneys.

View full drug information

Penicillin VK (Beepen-VK, Betapen-VK, Pen.Vee K, Robicillin VK, V-Cillin K, Veetids)

 

Inhibits the biosynthesis of cell wall mucopeptide. Bactericidal against sensitive organisms when adequate concentrations are reached, and most effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

View full drug information

Cephalexin (Keflex)

 

First-generation cephalosporin arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Primary activity against skin flora. Used for skin infections or prophylaxis in minor procedures.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Heather Murphy-Lavoie, MD, FAAEM  Assistant Professor, Section of Emergency Medicine and Hyperbaric Medicine, Louisiana State University School of Medicine, New Orleans; Clinical Instructor, Department of Surgery, Tulane University School of Medicine

Heather Murphy-Lavoie, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Micelle J Haydel, MD  Associate Clinical Professor of Medicine, Residency Director, Section of Emergency Medicine, Louisiana State University Health Science Center

Micelle J Haydel, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Sigma Theta Tau International, Society for Academic Emergency Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerome FX Naradzay, MD, FACEP  Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina

Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeter (Jay) Pritchard Taylor III, MD  Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

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

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Brook I. Aerobic and anaerobic microbiology of paronychia. Ann Emerg Med. Sep 1990;19(9):994-6. [Medline].

  2. Chronic paronychia: what you should know. Am Fam Physician. Feb 1 2008;77(3):347-8. [Medline].

  3. Rockwell PG. Acute and chronic paronychia. Am Fam Physician. Mar 15 2001;63(6):1113-6. [Medline].

  4. Canales FL, Newmeyer WL 3rd, Kilgore ES Jr. The treatment of felons and paronychias. Hand Clin. Nov 1989;5(4):515-23. [Medline].

  5. Dahdah MJ, Scher RK. Nail diseases related to nail cosmetics. Dermatol Clin. Apr 2006;24(2):233-9, vii. [Medline].

  6. Colson AE, Sax PE, Keller MJ, et al. Paronychia in association with indinavir treatment. Clin Infect Dis. Jan 2001;32(1):140-3. [Medline].

  7. Hijjawi JB, Dennison DG. Acute felon as a complication of systemic Paclitaxel therapy: case report and review of the literature. Hand. Sep 2007;2(3):101-3. [Medline].

  8. Eames T, Grabein B, Kroth J, Wollenberg A. Microbiological analysis of epidermal growth factor receptor inhibitor therapy-associated paronychia. J Eur Acad Dermatol Venereol. Aug 2010;24(8):958-60. [Medline].

  9. Tomková H, Kohoutek M, Zábojníková M, Pospísková M, Ostrízková L, Gharibyar M. Cetuximab-induced cutaneous toxicity. J Eur Acad Dermatol Venereol. Jun 2010;24(6):692-6. [Medline].

  10. Osio A, Mateus C, Soria JC, et al. Cutaneous side-effects in patients on long-term treatment with epidermal growth factor receptor inhibitors. Br J Dermatol. Sep 2009;161(3):515-21. [Medline].

  11. Gilbar P, Hain A, Peereboom VM. Nail toxicity induced by cancer chemotherapy. J Oncol Pharm Pract. Sep 2009;15(3):143-55. [Medline].

  12. Rigopoulos D, Gregoriou S, Belyayeva Y, Larios G, Gkouvi A, Katsambas A. Acute paronychia caused by lapatinib therapy. Clin Exp Dermatol. Jan 2009;34(1):94-5. [Medline].

  13. Kapellen TM, Galler A, Kiess W. Higher frequency of paronychia (nail bed infections) in pediatric and adolescent patients with type 1 diabetes mellitus than in non-diabetic peers. J Pediatr Endocrinol Metab. Jun 2003;16(5):751-8. [Medline].

  14. Tosti A, Piraccini BM, D'Antuono A, Marzaduri S, Bettoli V. Paronychia associated with antiretroviral therapy. Br J Dermatol. Jun 1999;140(6):1165-8. [Medline].

  15. Yip KM, Lam SL, Shee BW, Shun CT, Yang RS. Subungual squamous cell carcinoma: report of 2 cases. J Formos Med Assoc. Aug 2000;99(8):646-9. [Medline].

  16. Daniel CR 3rd. Paronychia. Dermatol Clin. Jul 1985;3(3):461-4. [Medline].

  17. Jules KT, Bonar PL. Nail infections. Clin Podiatr Med Surg. Apr 1989;6(2):403-16. [Medline].

  18. Muniz AE, Evans T. Chronic paronychia, osteomyelitis, and paravertebral abscess in a child with blastomycosis. J Emerg Med. Oct 2000;19(3):245-8. [Medline].

  19. Turkmen A, Warner RM, Page RE. Digital pressure test for paronychia. Br J Plast Surg. Jan 2004;57(1):93-4. [Medline].

  20. Riesbeck K. Paronychia due to Prevotella bivia that resulted in amputation: fast and correct bacteriological diagnosis is crucial. J Clin Microbiol. Oct 2003;41(10):4901-3. [Medline]. [Full Text].

  21. Daniel CR 3rd, Daniel MP, Daniel J, Sullivan S, Bell FE. Managing simple chronic paronychia and onycholysis with ciclopirox 0.77% and an irritant-avoidance regimen. Cutis. Jan 2004;73(1):81-5. [Medline].

  22. Fung V, Sainsbury DC, Seukeran DC, Allison KP. Squamous cell carcinoma of the finger masquerading as paronychia. J Plast Reconstr Aesthet Surg. Feb 2010;63(2):e191-2. [Medline].

  23. Engineer L, Norton LA, Ahmed AR. Nail involvement in pemphigus vulgaris. J Am Acad Dermatol. Sep 2000;43(3):529-35. [Medline].

  24. Patsatsi A, Sotiriou E, Devliotou-Panagiotidou D, Sotiriadis D. Pemphigus vulgaris affecting 19 nails. Clin Exp Dermatol. Mar 2009;34(2):202-5. [Medline].

  25. Jebson PJ. Infections of the fingertip. Paronychias and felons. Hand Clin. Nov 1998;14(4):547-55, viii. [Medline].

 
Previous
Next
 
Paronychia incision and drainage.
Paronychial erythema and edema with associated pustule. This suggests a bacterial etiology.
Paronychia, side view.
After simple drainage, there is purulent return.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.