Dawaa Reference

infectious

Pulp Space Infection of the Finger or Thumb (Felon)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Flucloxacillin monograph (chapter PDF p361) · Nardi NM, McDonald EJ, Syed HA, Schaefer TJ. Felon. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; last update April 30, 2024.

Verified against1 document
  • Egyptian National Drug Formulary - antimicrobial-2023.pdf, Flucloxacillin monograph (chapter PDF p361)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • The complaint is pain and redness of the fingertip [redness]
  • Injury to the finger may be remembered, but often no cause is found
  • Typically redness comes first, then swelling and pain follow [redness]
  • Pain starts mild and quickly becomes severe and throbbing, worse when the hand hangs down
  • The infection sits inside the closed compartments of the fingertip pulp
  • Red flag: left long enough it reaches the bone underneath, the joint or the tendons

Signs — what you find (5)

  • The fingertip pulp over the end bone is tense, red, and swollen without pitting
  • Swelling stops at the end bone, held back by the fibrous walls of the pulp
  • Pressure inside the pulp may burst it open by itself, which eases things only briefly
  • The tissues feel tense and fluctuant, and the tip is exquisitely tender to touch
  • Red flag: the tissue around it risks ischaemia once the swelling and the pus compress the blood flow [ischaemia · pus]

Tests (7)

  • Examining the finger is usually enough to make the diagnosis
  • Note any bone abnormality and check for signs the tip is losing its blood supply
  • Image the finger if something may have penetrated it
  • Imaging can also show a fracture, bone infection or gas in the tissues, pointing elsewhere
  • Gram stain and culture any discharge, to steer the antibiotic
  • Biopsy is very rarely needed
  • Red flag: without prompt incision and drainage together with antibiotics it destroys tissue, spreads into what lies next to it, and makes the patient systemically ill

If not this — what else fits (9)

  • Cellulitis of the finger
  • Dermatomyositis
  • A fingertip injury
  • Granuloma annulare
  • Bruising left by a pulse oximeter probe
  • Herpetic whitlow
  • Pyogenic granuloma
  • Paronychia around the nail fold
  • Reiter syndrome

SourceStatPearls "Felon" - disease-level clinical article

Presentation findings are traced to the source above.

1

FLUCLOXACILLIN

1st line

Formoral.solid

Adult dose and duration

250 mg orally (or by intramuscular injection) four times daily; the dose may be doubled for a severe infection. - As directed (formulary gives no fixed course length for this dose; a short course, e.g. 5-7 days, is typical clinical practice, reviewed against response).

Paediatric dose

Paediatric dosing is specialist-set and is not reproduced here.

Dose source

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Flucloxacillin monograph (chapter PDF p361)

Why

A felon is a closed-space staphylococcal soft-tissue infection, matching flucloxacillin's formulary indication for staphylococcal skin and soft-tissue infections; oral therapy is appropriate for early, non-fluctuant disease.

Cautions
  • Penicillin allergy is a contraindication - ask about prior reactions before prescribing.
  • A tense, fluctuant felon needs incision and drainage referral; antibiotics alone will not resolve a closed abscess and delay risks pulp necrosis.
  • Spreading redness up the finger or hand suggests tenosynovitis or cellulitis and needs urgent reassessment.
  • Diabetic or immunocompromised patients have a higher risk of rapid spread and a lower threshold for referral.
  • Rare but serious cholestatic jaundice/hepatitis can occur, more often with longer courses and in older patients - warn to stop and seek review if jaundice develops.
Egyptian brands
Egyptian brandManufacturerIndicative price
FLUMOCIN 250MG 12CAPS.! also contains amoxicillinUP PHARMA6.20 EGP (0.52/unit)
AMOFLUX 125/125MG 12 CAPS.! also contains amoxicillinRAMEDA > DELTA PHARMA8.25 EGP (0.69/unit)
FLUCAMOX 250MG 12CAPS.! also contains amoxicillinSEDICO8.25 EGP (0.69/unit)
FLUMOCIN 500MG 8 CAPS.! also contains amoxicillinUP PHARMA6.00 EGP (0.75/unit)
CURAFLUX 125/125 MG 12 CAPS.! also contains amoxicillinRAMEDA > PIONEER12.50 EGP (1.04/unit)
AMOFLUX 250/250MG 16 CAPS.! also contains amoxicillinRAMEDA > PIONEER18.00 EGP (1.12/unit)
HI-FLUCIL 250/250MG 16 CAPS.! also contains amoxicillinCID20.00 EGP (1.25/unit)
AMPIFLUX 500 MG 12 CAPS.! also contains ampicillinPHARCO16.00 EGP (1.33/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.