Empiric therapy for paronychia due to presumed oral flora

Agent of choice

Amoxicillin - clavulanate (875/125 mg twice daily)

Alternate empiric regimens include:

One of the following agents with activity against Eikenella:

Doxycycline* (100 mg twice daily)

Trimethoprim-sulfamethoxazole* (1 to 2 double-strength tablets twice daily)

Penicillin VK (500 mg four times daily)

Cefuroxime (500 mg twice daily)

Fluoroquinolones (one of the following):

• Ciprofloxacin (500 to 750 mg twice daily)

• Moxifloxacin (400 mg once daily)

PLUS

One of the following agents with anaerobic activity:

Metronidazole (500 mg three times daily)

Clindamycin* (450 mg three times daily)

The following agents have poor activity against Eikenella and should be avoided:

Cephalexin

Dicloxacillin

Erythromycin

Doses listed are for patients with normal renal function. Some patients require adjustment for renal impairment.

* Also active against methicillin-resistant Staphylococcus aureus (MRSA; check susceptibility testing).

Graphic 80408 Version 4.0