Paronychia Medication

Updated: May 10, 2022
  • Author: Elizabeth M Billingsley, MD; Chief Editor: William D James, MD  more...
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Medication Summary

Most paronychia infections can be managed without antibiotics; over-the-counter analgesics are usually sufficient. If cellulitis is present, however, then antibiotics are indicated. Although penicillin covers oral flora, it does not cover methicillin-resistant Staphylococcus aureus (MRSA). Trimethoprim and sulfamethoxazole (TMP/SMZ), doxycycline, or clindamycin may be considered to cover community-acquired MRSA and anaerobic organisms. Cephalexin may also be effective. Combination therapy with an intravenous agent that provides antimicrobial activity against staphylococci is used for inpatient therapy.

Chronic paronychial infections are usually managed with oral antifungals such as ketoconazole, itraconazole, or fluconazole. [43] Many of these agents require a prolonged course with monitoring of laboratory tests to avoid complications.



Class Summary

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

Clindamycin (Cleocin)

This agent is a lincosamide used in the treatment of serious skin and soft tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (except enterococci). Clindamycin inhibits bacterial growth, possibly by blocking the dissociation of peptidyl transfer ribonucleic acid (t-RNA) from ribosomes, causing RNA-dependent protein synthesis to arrest.

Clindamycin widely distributes in the body without penetration of the central nervous system (CNS). It is protein bound and excreted by the liver and kidneys.

Amoxicillin and clavulanic acid (Augmentin, Augmentin XR, Amoclan)

This drug combination is used against bacteria resistant to beta-lactam antibiotics. In children over age 3 months, base dosing protocol on amoxicillin content. Because the amoxicillin/clavulanic acid ratio in 250-mg tablets (250/125) is different than in 250-mg chewable tablets (250/62.5), do not use 250-mg tablets until the child weighs more than 40 kg.

Penicillin VK

Penicillin VK inhibits the biosynthesis of cell wall mucopeptide. It is bactericidal against sensitive organisms when adequate concentrations are reached. It is most effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

Cephalexin (Keflex)

This is a first-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. It has bactericidal activity against rapidly growing organisms, with primary activity against skin flora. It is used for skin infections or for prophylaxis in minor procedures.



Class Summary

The mechanism of action of antifungal agents usually involves the alteration of the permeability of the cell membrane (polyenes) of the fungal cell or the inhibition of pathways (enzymes, substrates, transport) necessary for sterol/cell membrane synthesis.

Miconazole topical (Desenex Spray, Lotrimin AF, Baza Antifungal, Carrington Antifungal, Micaderm, Micatin)

This agent damages the fungal cell wall membrane by inhibiting the biosynthesis of ergosterol. By increasing membrane permeability, it causes nutrients to leak out of the cell, resulting in fungal cell death. Lotion is preferred in intertriginous areas. If cream is used, it should be applied sparingly to avoid maceration effects.

Ketoconazole (Nizoral, Extina, Xologel)

Ketoconazole has fungistatic activity. An imidazole with broad-spectrum antifungal action, it inhibits the synthesis of ergosterol, causing cellular components to leak and resulting in fungal cell death.

Itraconazole (Sporanox, Onmel)

This is a synthetic fungistatic triazole that inhibits cytochrome P-450–dependent synthesis of ergosterol, a vital component of fungal cell membranes.