Acute paronychia

Acute paronychia is an infection of the nail fold, usually caused by staphylococcal bacteria. It often occurs at the cuticle or at the site of a hangnail or other injury. The area around the nail becomes painful, red and swollen. Acute paronychia may aggravate chronic paronychia.

If collection of pus is visible, drain the pus.

For acute paronychia that does not respond to local drainage, or does not require drainage, take a swab and start empirical antibiotic therapy. Use:

1dicloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days dicloxacillin dicloxacillin dicloxacillin

OR

1flucloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days. flucloxacillin flucloxacillin flucloxacillin

For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin1, use:

cefalexin 1 g (child: 25 mg/kg up to 1 g) orally, 12-hourly for 5 days. cefalexin cefalexin cefalexin

For patients who have had a severe (immediate or delayed)2 hypersensitivity reaction to a penicillin, use:

1clindamycin 450 mg (child 1 month or older: 10 mg/kg up to 450 mg) orally, 8-hourly for 5 days clindamycin clindamycin clindamycin

OR

1trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or older: 4+20 mg/kg up to 160+800 mg) orally, 12-hourly for 5 days. trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole

Refer unresponsive cases for dermatologist advice.

1 Cefalexin may be used in patients who have had a nonsevere (immediate or delayed) reaction to amoxicillin or ampicillin. However, because cross-reactivity between these drugs is possible, consideration should be given to the extent of the reaction, patient acceptability, and the suitability of non–beta-lactam options.Return
2 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return