What should I do if there is no response to antibiotics (acute paronychia)?
• If there is no response to antibiotics within 5–7 days or the paronychia is getting worse over 48 hours despite antibiotic treatment: • Take a swab of any pus or discharge to confirm the infecting organism (choice of antibiotic should be guided by sensitivities). • Incise and drain if the paronychia is fluctuant and this has not already been done (this can be done locally if the skills to do this exist within the practice, or alternatively refer). • If there is no pus to swab, and incision and drainage of the paronychia is not appropriate: • If the person is able to take penicillin, change the antibiotic to co-amoxiclav. • If the person is allergic to penicillin, continue erythromycin (or clarithromycin if the person is unable to tolerate erythromycin) and add metronidazole. • If there is no response to the change in antibiotic, consider candidal infection (especially if person has frequently wet hands). • Swab for mycological culture, and if positive for candida, treat with a topica
