What are the indications for antibiotic therapy in cases of paronychia?

Antibiotic therapy in cases of paronychia is indicated when:

• Incision and drainage is not performed.
• Incision and drainage has been performed but the person has significant pain, involvement of an extended area of periungual tissue, signs of cellulitis or fever, or other comorbidities such as diabetes or immunosuppression.
• The paronychia is enlarging, involves inflammation of surrounding tissue, is recurrent, or has not responded to treatment within 2 to 3 days.
• The person is systemically unwell or has a history of contact with methicillin-resistant Staphylococcus aureus (MRSA).
• The person is immunosuppressed or has diabetes.

Flucloxacillin is recommended as the first-line oral antibiotic, with clarithromycin or erythromycin as alternatives, especially in pregnancy. Specialist advice should be sought if MRSA infection is suspected or confirmed.