# Acute Paronychia - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: NICE Clinical Knowledge Summaries: Paronychia - acute 2021 · Egyptian National Drug Formulary - Antimicrobial 2023 (fusidic acid monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) · No labelled dose - a procedure, not a medicine · Paronychia - StatPearls - NCBI Bookshelf (NBK544307); duration and paediatric dose from Cephalexin US label, SetID 0a24b6e5-6f13-44b4-93f4-47c86945cad2, section 2 - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023 (fusidic acid monograph) - Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) - No labelled dose - a procedure, not a medicine - Acute Paronychia - disease-level clinical article (paronychia-full.txt) - Acute Paronychia - disease-level clinical article (paronychia-clinical.txt) ## Treatment metadata - Warm water soak and local care - Referral & safety-netting (no drug therapy) - Amoxicillin + Clavulanic acid — 625 mg — oral.solid - Clindamycin — 300 mg — oral.solid - Cefalexin — 500 mg — oral.solid - Fusidic acid — topical ## Complete treatment card ```text ACUTE PARONYCHIA Sources: NICE Clinical Knowledge Summaries: Paronychia - acute 2021 · Egyptian National Drug Formulary - Antimicrobial 2023 (fusidic acid monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) · No labelled dose - a procedure, not a medicine · Paronychia - StatPearls - NCBI Bookshelf (NBK544307); duration and paediatric dose from Cephalexin US label, SetID 0a24b6e5-6f13-44b4-93f4-47c86945cad2, section 2 Review status: REVIEWED against Egyptian National Drug Formulary - Antimicrobial 2023 (fusidic acid monograph), Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph), No labelled dose - a procedure, not a medicine, Acute Paronychia - disease-level clinical article (paronychia-full.txt), Acute Paronychia - disease-level clinical article (paronychia-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Painful redness and swelling of the skin fold beside the nail, usually prompting a visit within days [redness] - History often includes recent trauma, infection, or an inflammatory skin condition - Occupations with frequent hand-wetting, such as bartending or dishwashing, favor the chronic form [urinary incontinence] - It is one of the commonest infections of the hand - It can start by itself, or follow an injury or any handling of the nail SIGNS - what you find (4) - The lateral nail fold is red, swollen, and tender on examination - A wider-than-usual blanched area on the digital pressure test signals a hidden abscess needing drainage [abscess] - In the chronic form the fold looks boggy and the nail plate thickens and discolors - The seal between nail and fold breaks, bacteria get in behind it, and the infection follows IF NOT THIS - what else fits (6) - Absence of fluctuance despite diffuse erythema and swelling points away from paronychia toward cellulitis - Intense pain with a tense, warm fingertip pulp, not just the nail fold, suggests a felon instead - Vesicles or vesicopustules with a burning, itchy prodrome point to herpetic whitlow, which must not be incised - Yellow-white nail discoloration without acute tenderness suggests fungal onychomycosis instead - A non-healing nail-fold lesion can actually be a rare subungual squamous cell carcinoma masquerading as paronychia - The acute kind takes one nail only, so several nails at once means suspect a drug cause Source StatPearls "Paronychia" - disease-level clinical article Status traced to the source above Rx: Main treatment | Oral antibiotic - plain staphylococcal cover MAIN TREATMENT - choose one, plus any add-on marked below 1. WARM WATER SOAK AND LOCAL CARE [1st line] Adult Soak affected digit in warm water for 15-20 minutes three to four times daily x 7 days or until resolved Peds Soak affected digit in warm water 3-4 times daily under adult supervision Source No labelled dose - a procedure, not a medicine Why Warm water soaks are a non-drug measure that softens the skin and encourages the paronychia to drain spontaneously, and form the mainstay of care for early, non- fluctuant infection. Caution Do not attempt home drainage with non-sterile instruments. Seek urgent evaluation if red streaks extend up finger/toe (lymphangitis) or fever develops. 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Paronychia - disease-level clinical article (paronychia-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Refer to a hand surgeon when infection spreads to underlying tendons or is severe (debridement/washout/amputation may be needed). RED FLAG - Follow-up requirement within 24-48 hours after drainage to check for worsening infection is not mentioned 3. AMOXICILLIN + CLAVULANIC ACID [2nd line] Adult 625 mg (500/125) three times daily or 1000 mg (875/125) twice daily x 7 days Peds 25-45 mg/kg/day [child max 1750 mg] (25-45 mg/kg/day (based on amoxicillin component) divided twice daily for 7 days) 3kg -> 75-135 mg/day 4kg -> 100-180 mg/day 5kg -> 125-225 mg/day 6kg -> 150-270 mg/day 7kg -> 175-315 mg/day 8kg -> 200-360 mg/day 9kg -> 225-405 mg/day 10kg -> 250-450 mg/day 11kg -> 275-495 mg/day 12kg -> 300-540 mg/day 13kg -> 325-585 mg/day 14kg -> 350-630 mg/day 15kg -> 375-675 mg/day 16kg -> 400-720 mg/day 17kg -> 425-765 mg/day 18kg -> 450-810 mg/day 19kg -> 475-855 mg/day 20kg -> 500-900 mg/day 21kg -> 525-945 mg/day 22kg -> 550-990 mg/day 23kg -> 575-1035 mg/day 24kg -> 600-1080 mg/day 25kg -> 625-1125 mg/day 26kg -> 650-1170 mg/day 27kg -> 675-1215 mg/day 28kg -> 700-1260 mg/day 29kg -> 725-1305 mg/day 30kg -> 750-1350 mg/day 31kg -> 775-1395 mg/day 32kg -> 800-1440 mg/day 33kg -> 825-1485 mg/day 34kg -> 850-1530 mg/day 35kg -> 875-1575 mg/day 36kg -> 900-1620 mg/day 37kg -> 925-1665 mg/day 38kg -> 950-1710 mg/day 39kg -> 975-1750 mg/day (upper capped) 40kg -> 1000-1750 mg/day (upper capped) 41kg -> 1025-1750 mg/day (upper capped) 42kg -> 1050-1750 mg/day (upper capped) 43kg -> 1075-1750 mg/day (upper capped) 44kg -> 1100-1750 mg/day (upper capped) 45kg -> 1125-1750 mg/day (upper capped) 46kg -> 1150-1750 mg/day (upper capped) 47kg -> 1175-1750 mg/day (upper capped) 48kg -> 1200-1750 mg/day (upper capped) 49kg -> 1225-1750 mg/day (upper capped) 50kg -> 1250-1750 mg/day (upper capped) Choice Clindamycin is one of the article's options for MRSA cover, not the default. Source Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) Why Amoxicillin-clavulanate is an oral antibiotic covering staphylococci and anaerobes, used when paronychia is more extensive or fails topical therapy; incision and drainage of any fluctuant abscess remains essential alongside it. Caution Contraindicated in history of penicillin anaphylaxis or amoxicillin/clavulanate- associated jaundice. Incision and drainage of fluctuant abscess remains essential alongside antibiotics. Reduce dose in severe renal impairment. Egypt AUJED 625 MG 12 F.C. TAB. SIGMA TEC > J... 19.20 EGP (1.60/unit) E-MOXCLAV 625MG 10 TAB. EIPICO 30.00 EGP (3.00/unit) DEXICLAVE 625 MG 12 F.C. TABS. RAMEDA > NOVE... 37.50 EGP (3.12/unit) MAGNABIOTIC 625MG 8 TAB. SEDICO 37.00 EGP (4.62/unit) CLAVIMOX 625 MG 12 F.C.TABS. PHARCO 107.00 EGP (8.92/unit) CURAM 625MG 12 F.C.TAB. SANDOZ > NOVA... 108.00 EGP (9.00/unit) AUGMENTIN 625 MG 10 F.C.TABS. MUP > SMITHKL... 117.00 EGP (11.70/unit) CLAVOCILLIN 625 MG 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 31.50 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid 4. CLINDAMYCIN [2nd line] Adult Oral: 300–450 mg every 6 hours. x 7 days Peds 20-40 mg/kg/day [child max 1800 mg] (Oral: Infants, Children, and Adolescents: 8 to 20 mg/kg/day divided every 6 to 8 hours (or 20 to 40 mg/kg/day for severe infections, max 1800 mg daily).) 3kg -> 60-120 mg/day 4kg -> 80-160 mg/day 5kg -> 100-200 mg/day 6kg -> 120-240 mg/day 7kg -> 140-280 mg/day 8kg -> 160-320 mg/day 9kg -> 180-360 mg/day 10kg -> 200-400 mg/day 11kg -> 220-440 mg/day 12kg -> 240-480 mg/day 13kg -> 260-520 mg/day 14kg -> 280-560 mg/day 15kg -> 300-600 mg/day 16kg -> 320-640 mg/day 17kg -> 340-680 mg/day 18kg -> 360-720 mg/day 19kg -> 380-760 mg/day 20kg -> 400-800 mg/day 21kg -> 420-840 mg/day 22kg -> 440-880 mg/day 23kg -> 460-920 mg/day 24kg -> 480-960 mg/day 25kg -> 500-1000 mg/day 26kg -> 520-1040 mg/day 27kg -> 540-1080 mg/day 28kg -> 560-1120 mg/day 29kg -> 580-1160 mg/day 30kg -> 600-1200 mg/day 31kg -> 620-1240 mg/day 32kg -> 640-1280 mg/day 33kg -> 660-1320 mg/day 34kg -> 680-1360 mg/day 35kg -> 700-1400 mg/day 36kg -> 720-1440 mg/day 37kg -> 740-1480 mg/day 38kg -> 760-1520 mg/day 39kg -> 780-1560 mg/day 40kg -> 800-1600 mg/day 41kg -> 820-1640 mg/day 42kg -> 840-1680 mg/day 43kg -> 860-1720 mg/day 44kg -> 880-1760 mg/day 45kg -> 900-1800 mg/day 46kg -> 920-1800 mg/day (upper capped) 47kg -> 940-1800 mg/day (upper capped) 48kg -> 960-1800 mg/day (upper capped) 49kg -> 980-1800 mg/day (upper capped) 50kg -> 1000-1800 mg/day (upper capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Oral lincosamide antibiotic providing anti-staphylococcal coverage for acute paronychia. Caution Hypersensitivity to clindamycin, lincomycin, or any component of the formulation. High risk of Clostridioides difficile-associated diarrhea (CDAD); discontinue if significant diarrhea occurs. Egypt ADCOCLINDACE 300 MG 16 CAPS. ARAB DRUG COM... 24.00 EGP (1.50/unit) CLINACYN 300MG 16 CAPS. SIGMA > EGYPT... 31.50 EGP (1.97/unit) CLINDAM 300 MG 16 CAPS. SIGMA > OCTOB... 75.00 EGP (4.69/unit) MEPACLIND 300MG 8 CAPS. MEPACO 38.00 EGP (4.75/unit) CLINDACINE ART 300 MG 12 CAPS. RAMEDA > ART ... 76.00 EGP (6.33/unit) ALFACLINDAMYCIN 300 MG 10 CAPS. ATCO PHARMA >... 69.00 EGP (6.90/unit) DALACIN C 300MG 10 CAPS. PFIZER 114.00 EGP (11.40/unit) KLENDABIOTICAM 1 % TOP. SOLUTION PANAX PHARMA 8.50 EGP -> ? strength differs, ? different route - not oral solid ADCOCLINDACE 10MG/ML TOP. SOL. ARAB DRUG COM... 12.00 EGP -> ? strength differs, ? different route - not oral solid 5. FUSIDIC ACID [add-on - not a substitute] Adult Apply 2% ointment or cream to affected nail fold two to three times daily after warm water soak x 7 days Peds Apply 2% cream or ointment 2 to 3 times daily for 7 to 14 days. Source Egyptian National Drug Formulary - Antimicrobial 2023 (fusidic acid monograph) Why Fusidic acid is a topical antibiotic active against the Staphylococcus aureus that usually causes acute paronychia; it is used alongside warm soaks and drainage of any abscess, not as a substitute for drainage. Caution Perform incision and drainage if a fluctuant abscess is present. Avoid biting nails or picking cuticles. If infection spreads or fails to resolve within 7 days, initiate oral antibiotics. Egypt FOSTINO 2% TOPICAL GEL 15 GM ZAD 8.00 EGP ANESTY 2% TOPICAL GEL 15GM MARCYRL PHARM... 8.50 EGP FUSIDIC ACID 2% GEL 15 GM SIGMA 8.50 EGP FUSIDICTAM 2 % TOP. CREAM 30 GM MEDIZEN PHARM... 26.50 EGP FUCI-TOP 2% CREAM 15 GM HIKMA PHARMA 44.00 EGP FUCIDIN 2% CREAM 15 GM MINA PHARM > ... 56.00 EGP FUCIDIN 2% CREAM 30 GM MINA PHARM > ... 96.00 EGP FUCIDIN 2% OINTMENT 30 GM MINA PHARM > ... 96.00 EGP ORAL ANTIBIOTIC - PLAIN STAPHYLOCOCCAL COVER 6. CEFALEXIN [2nd line] Adult 500 mg three to four times a day x 7 to 14 days Peds 25-50 mg/kg/day [child max 2000 mg] (Children: a total of 25 to 50 mg/kg a day in divided doses for 7 to 14 days. Maximum 2,000 mg a day (Egyptian National Drug Formulary - Antimicrobial 2023, cephalexin monograph).) 3kg -> 75-150 mg/day 4kg -> 100-200 mg/day 5kg -> 125-250 mg/day 6kg -> 150-300 mg/day 7kg -> 175-350 mg/day 8kg -> 200-400 mg/day 9kg -> 225-450 mg/day 10kg -> 250-500 mg/day 11kg -> 275-550 mg/day 12kg -> 300-600 mg/day 13kg -> 325-650 mg/day 14kg -> 350-700 mg/day 15kg -> 375-750 mg/day 16kg -> 400-800 mg/day 17kg -> 425-850 mg/day 18kg -> 450-900 mg/day 19kg -> 475-950 mg/day 20kg -> 500-1000 mg/day 21kg -> 525-1050 mg/day 22kg -> 550-1100 mg/day 23kg -> 575-1150 mg/day 24kg -> 600-1200 mg/day 25kg -> 625-1250 mg/day 26kg -> 650-1300 mg/day 27kg -> 675-1350 mg/day 28kg -> 700-1400 mg/day 29kg -> 725-1450 mg/day 30kg -> 750-1500 mg/day 31kg -> 775-1550 mg/day 32kg -> 800-1600 mg/day 33kg -> 825-1650 mg/day 34kg -> 850-1700 mg/day 35kg -> 875-1750 mg/day 36kg -> 900-1800 mg/day 37kg -> 925-1850 mg/day 38kg -> 950-1900 mg/day 39kg -> 975-1950 mg/day 40kg -> 1000-2000 mg/day 41kg -> 1025-2000 mg/day (upper capped) 42kg -> 1050-2000 mg/day (upper capped) 43kg -> 1075-2000 mg/day (upper capped) 44kg -> 1100-2000 mg/day (upper capped) 45kg -> 1125-2000 mg/day (upper capped) 46kg -> 1150-2000 mg/day (upper capped) 47kg -> 1175-2000 mg/day (upper capped) 48kg -> 1200-2000 mg/day (upper capped) 49kg -> 1225-2000 mg/day (upper capped) 50kg -> 1250-2000 mg/day (upper capped) Source Paronychia - StatPearls - NCBI Bookshelf (NBK544307); duration and paediatric dose from Cephalexin US label, SetID 0a24b6e5-6f13-44b4-93f4-47c86945cad2, section 2; paediatric ceiling from Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph) Why Acute paronychia is a staphylococcal infection, so the article's oral choice after failed topical treatment is a plain anti-staphylococcal agent. The card jumps straight to co-amoxiclav and clindamycin, which are the choices for suspected oral inoculation or anaerobic cover, not for the ordinary case. Caution Do not use it in anyone with known hypersensitivity to cephalexin or any other cephalosporin. It has no anaerobic cover - if the paronychia may have been seeded from the mouth, or the patient has MRSA risk factors, this is the wrong row. Egypt CEFLODIX 500 MG 12 CAPS. ARAB CAPS > P... 9.00 EGP (0.75/unit) CEPHALEXCID 500 MG 12 CAPS. CID 10.30 EGP (0.86/unit) CEPHOXIN 500MG 12 TAB. PHARCO B 10.50 EGP (0.88/unit) CEPHALEXIN 500MG 10 CAPS. ARAB DRUG COM... 10.10 EGP (1.01/unit) MEDICEFLEXIN 500 MG 20 CAPS. T3A PHARMA > ... 25.25 EGP (1.26/unit) CEPHALEXIN 500MG 12 CAPS B.P.2007 SHIFA MEDICAL PRODUCTS > O... 27.00 EGP (2.25/unit) KEFLEX 500 MG 12 CAPS. HIKMA PHARMA 58.00 EGP (4.83/unit) CEPOREX 500MG 12 TABS. GLAXO SMITHKLINE 69.00 EGP (5.75/unit) AMTHROST 125MG/5ML SUSP. 60ML SIGMA > SABAA 4.00 EGP -> ? strength differs, ? different route - not oral solid AMTHROST 250MG/5ML SUSP. 60ML SIGMA > SABAA 4.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)