Dawaa Reference

infectious

Acute Paronychia

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

Evidence status

Checked against the sources named below

Sources5 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 against5 documents
  • 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)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Paronychia" - disease-level clinical article

Presentation findings are 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 dose and duration

Soak affected digit in warm water for 15-20 minutes three to four times daily x 7 days or until resolved

Paediatric dose

Soak affected digit in warm water 3-4 times daily under adult supervision

Dose 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.

Cautions
  • 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
Dose 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.

Cautions
  • 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

Strength625 mg

Formoral.solid

Adult dose and duration

625 mg (500/125) three times daily or 1000 mg (875/125) twice daily x 7 days

Paediatric dose

25-45 mg/kg/day [child max 1750 mg]

(25-45 mg/kg/day (based on amoxicillin component) divided twice daily for 7 days)

Dose by weight
3kg75-135 mg/day
4kg100-180 mg/day
5kg125-225 mg/day
6kg150-270 mg/day
7kg175-315 mg/day
8kg200-360 mg/day
9kg225-405 mg/day
10kg250-450 mg/day
11kg275-495 mg/day
12kg300-540 mg/day
13kg325-585 mg/day
14kg350-630 mg/day
15kg375-675 mg/day
16kg400-720 mg/day
17kg425-765 mg/day
18kg450-810 mg/day
19kg475-855 mg/day
20kg500-900 mg/day
21kg525-945 mg/day
22kg550-990 mg/day
23kg575-1035 mg/day
24kg600-1080 mg/day
25kg625-1125 mg/day
26kg650-1170 mg/day
27kg675-1215 mg/day
28kg700-1260 mg/day
29kg725-1305 mg/day
30kg750-1350 mg/day
31kg775-1395 mg/day
32kg800-1440 mg/day
33kg825-1485 mg/day
34kg850-1530 mg/day
35kg875-1575 mg/day
36kg900-1620 mg/day
37kg925-1665 mg/day
38kg950-1710 mg/day
39kg975-1750 mg/day (upper capped)
40kg1000-1750 mg/day (upper capped)
41kg1025-1750 mg/day (upper capped)
42kg1050-1750 mg/day (upper capped)
43kg1075-1750 mg/day (upper capped)
44kg1100-1750 mg/day (upper capped)
45kg1125-1750 mg/day (upper capped)
46kg1150-1750 mg/day (upper capped)
47kg1175-1750 mg/day (upper capped)
48kg1200-1750 mg/day (upper capped)
49kg1225-1750 mg/day (upper capped)
50kg1250-1750 mg/day (upper capped)
Choice

Clindamycin is one of the article's options for MRSA cover, not the default.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
AUJED 625 MG 12 F.C. TAB.SIGMA TEC > JEDCO INT. CO. FOR PHARMACEUTICALS19.20 EGP (1.60/unit)
E-MOXCLAV 625MG 10 TAB.EIPICO30.00 EGP (3.00/unit)
DEXICLAVE 625 MG 12 F.C. TABS.RAMEDA > NOVELL PHARMA37.50 EGP (3.12/unit)
MAGNABIOTIC 625MG 8 TAB.SEDICO37.00 EGP (4.62/unit)
CLAVIMOX 625 MG 12 F.C.TABS.PHARCO107.00 EGP (8.92/unit)
CURAM 625MG 12 F.C.TAB.SANDOZ > NOVARTIS108.00 EGP (9.00/unit)
AUGMENTIN 625 MG 10 F.C.TABS.MUP > SMITHKLINE BEECHAM117.00 EGP (11.70/unit)
CLAVOCILLIN 625 MG 10 DISPERSIBLE TABS.RAMEDA > ORGANOPHARMA31.50 EGP
LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML? strength differs? different route - not oral solidMISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.8.00 EGP
MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML? strength differs? different route - not oral solidCID8.00 EGP
4

CLINDAMYCIN

2nd line

Strength300 mg

Formoral.solid

Adult dose and duration

Oral: 300–450 mg every 6 hours. x 7 days

Paediatric dose

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).)

Dose by weight
3kg60-120 mg/day
4kg80-160 mg/day
5kg100-200 mg/day
6kg120-240 mg/day
7kg140-280 mg/day
8kg160-320 mg/day
9kg180-360 mg/day
10kg200-400 mg/day
11kg220-440 mg/day
12kg240-480 mg/day
13kg260-520 mg/day
14kg280-560 mg/day
15kg300-600 mg/day
16kg320-640 mg/day
17kg340-680 mg/day
18kg360-720 mg/day
19kg380-760 mg/day
20kg400-800 mg/day
21kg420-840 mg/day
22kg440-880 mg/day
23kg460-920 mg/day
24kg480-960 mg/day
25kg500-1000 mg/day
26kg520-1040 mg/day
27kg540-1080 mg/day
28kg560-1120 mg/day
29kg580-1160 mg/day
30kg600-1200 mg/day
31kg620-1240 mg/day
32kg640-1280 mg/day
33kg660-1320 mg/day
34kg680-1360 mg/day
35kg700-1400 mg/day
36kg720-1440 mg/day
37kg740-1480 mg/day
38kg760-1520 mg/day
39kg780-1560 mg/day
40kg800-1600 mg/day
41kg820-1640 mg/day
42kg840-1680 mg/day
43kg860-1720 mg/day
44kg880-1760 mg/day
45kg900-1800 mg/day
46kg920-1800 mg/day (upper capped)
47kg940-1800 mg/day (upper capped)
48kg960-1800 mg/day (upper capped)
49kg980-1800 mg/day (upper capped)
50kg1000-1800 mg/day (upper capped)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

Oral lincosamide antibiotic providing anti-staphylococcal coverage for acute paronychia.

Cautions
  • Hypersensitivity to clindamycin, lincomycin, or any component of the formulation.
  • High risk of Clostridioides difficile-associated diarrhea (CDAD); discontinue if significant diarrhea occurs.
Egyptian brands
Egyptian brandManufacturerIndicative price
ADCOCLINDACE 300 MG 16 CAPS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.50/unit)
CLINACYN 300MG 16 CAPS.SIGMA > EGYPTIAN PHARMACISTS COMPANY31.50 EGP (1.97/unit)
CLINDAM 300 MG 16 CAPS.SIGMA > OCTOBER PHARMA75.00 EGP (4.69/unit)
MEPACLIND 300MG 8 CAPS.MEPACO38.00 EGP (4.75/unit)
CLINDACINE ART 300 MG 12 CAPS.RAMEDA > ART PHARMA76.00 EGP (6.33/unit)
ALFACLINDAMYCIN 300 MG 10 CAPS.ATCO PHARMA > ROTABIOGEN69.00 EGP (6.90/unit)
DALACIN C 300MG 10 CAPS.PFIZER114.00 EGP (11.40/unit)
KLENDABIOTICAM 1 % TOP. SOLUTION? strength differs? different route - not oral solidPANAX PHARMA8.50 EGP
ADCOCLINDACE 10MG/ML TOP. SOL.? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)12.00 EGP
5

FUSIDIC ACID

add-on - not a substitute

Formtopical

Adult dose and duration

Apply 2% ointment or cream to affected nail fold two to three times daily after warm water soak x 7 days

Paediatric dose

Apply 2% cream or ointment 2 to 3 times daily for 7 to 14 days.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
FOSTINO 2% TOPICAL GEL 15 GMZAD8.00 EGP
ANESTY 2% TOPICAL GEL 15GMMARCYRL PHARMACEUTICAL INDUSTRIES (MPI)8.50 EGP
FUSIDIC ACID 2% GEL 15 GMSIGMA8.50 EGP
FUSIDICTAM 2 % TOP. CREAM 30 GMMEDIZEN PHARMACEUTICAL INDUSTRIES > MAGIC PHARMA-EGYPT26.50 EGP
FUCI-TOP 2% CREAM 15 GMHIKMA PHARMA44.00 EGP
FUCIDIN 2% CREAM 15 GMMINA PHARM > LEO PHARMACEUTICAL PRODUCTS56.00 EGP
FUCIDIN 2% CREAM 30 GMMINA PHARM > LEO PHARMACEUTICAL PRODUCTS96.00 EGP
FUCIDIN 2% OINTMENT 30 GMMINA PHARM > LEO PHARMACEUTICAL PRODUCTS96.00 EGP

ORAL ANTIBIOTIC - PLAIN STAPHYLOCOCCAL COVER

6

CEFALEXIN

Oral antibiotic - plain staphylococcal cover

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg three to four times a day x 7 to 14 days

Paediatric dose

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).)

Dose by weight
3kg75-150 mg/day
4kg100-200 mg/day
5kg125-250 mg/day
6kg150-300 mg/day
7kg175-350 mg/day
8kg200-400 mg/day
9kg225-450 mg/day
10kg250-500 mg/day
11kg275-550 mg/day
12kg300-600 mg/day
13kg325-650 mg/day
14kg350-700 mg/day
15kg375-750 mg/day
16kg400-800 mg/day
17kg425-850 mg/day
18kg450-900 mg/day
19kg475-950 mg/day
20kg500-1000 mg/day
21kg525-1050 mg/day
22kg550-1100 mg/day
23kg575-1150 mg/day
24kg600-1200 mg/day
25kg625-1250 mg/day
26kg650-1300 mg/day
27kg675-1350 mg/day
28kg700-1400 mg/day
29kg725-1450 mg/day
30kg750-1500 mg/day
31kg775-1550 mg/day
32kg800-1600 mg/day
33kg825-1650 mg/day
34kg850-1700 mg/day
35kg875-1750 mg/day
36kg900-1800 mg/day
37kg925-1850 mg/day
38kg950-1900 mg/day
39kg975-1950 mg/day
40kg1000-2000 mg/day
41kg1025-2000 mg/day (upper capped)
42kg1050-2000 mg/day (upper capped)
43kg1075-2000 mg/day (upper capped)
44kg1100-2000 mg/day (upper capped)
45kg1125-2000 mg/day (upper capped)
46kg1150-2000 mg/day (upper capped)
47kg1175-2000 mg/day (upper capped)
48kg1200-2000 mg/day (upper capped)
49kg1225-2000 mg/day (upper capped)
50kg1250-2000 mg/day (upper capped)
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
CEFLODIX 500 MG 12 CAPS.ARAB CAPS > PHAROPHARMA9.00 EGP (0.75/unit)
CEPHALEXCID 500 MG 12 CAPS.CID10.30 EGP (0.86/unit)
CEPHOXIN 500MG 12 TAB.PHARCO B10.50 EGP (0.88/unit)
CEPHALEXIN 500MG 10 CAPS.ARAB DRUG COMPANY (ADCO)10.10 EGP (1.01/unit)
MEDICEFLEXIN 500 MG 20 CAPS.T3A PHARMA > RIVA PHARMA S.A.E.25.25 EGP (1.26/unit)
CEPHALEXIN 500MG 12 CAPS B.P.2007SHIFA MEDICAL PRODUCTS > OCTOBER PHARMA27.00 EGP (2.25/unit)
KEFLEX 500 MG 12 CAPS.HIKMA PHARMA58.00 EGP (4.83/unit)
CEPOREX 500MG 12 TABS.GLAXO SMITHKLINE69.00 EGP (5.75/unit)
AMTHROST 125MG/5ML SUSP. 60ML? strength differs? different route - not oral solidSIGMA > SABAA4.00 EGP
AMTHROST 250MG/5ML SUSP. 60ML? strength differs? different route - not oral solidSIGMA > SABAA4.50 EGP

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