What Antibiotic Treats an Infected Toenail? A Guide to Prescription Medication

October 11, 2025 •

4 min read

Paronychia, a common bacterial infection of the skin around a nail, can affect the toenail, often as a result of an ingrown nail. Knowing what antibiotic treats an infected toenail is crucial, but requires a professional medical diagnosis to ensure the right course of action is taken.

Quick Summary

A bacterial toenail infection typically requires a prescription oral antibiotic, like cephalexin or clindamycin, rather than a topical cream, for effective treatment. Proper wound care and addressing the underlying cause, such as an ingrown nail, are also essential for resolution.

Key Points

Prescription Oral Antibiotics: Moderate to severe bacterial toenail infections require a prescription oral antibiotic like cephalexin or clindamycin, prescribed by a healthcare provider.
Not for Fungal Infections: Antibiotics are ineffective against fungal toenail infections (onychomycosis), which require antifungal medication.
Topicals are Limited: Topical antibiotic ointments are generally not strong enough for moderate to severe bacterial infections but can be used for very mild, superficial issues.
Underlying Cause Matters: For infected ingrown toenails, treating the underlying nail problem, often with partial nail removal, is as important as the antibiotic therapy.
When to See a Doctor: Increased pain, pus, red streaks, or underlying health conditions like diabetes are reasons to seek prompt medical attention.
Proper Hygiene is Key: Supporting measures like warm water soaks and proper foot hygiene are essential components of the overall treatment plan.

An infected toenail, often stemming from an ingrown nail or trauma, can cause significant pain, swelling, and redness in the soft tissue surrounding the nail. While many at-home remedies can provide relief for simple ingrown toenails, a bacterial infection requires prompt professional attention and, in many cases, antibiotics. The most effective antibiotic choice depends on the severity of the infection and the specific bacteria responsible, making a proper diagnosis by a healthcare provider paramount.

Understanding Bacterial vs. Fungal Toenail Infections

Not all toenail issues are the same, and mistaking a fungal infection for a bacterial one will lead to ineffective treatment. It is critical to know the difference before considering antibiotics.

Bacterial Toenail Infection (Paronychia)

Causes: Bacteria, most commonly Staphylococcus aureus or streptococci, enter the skin through a break in the cuticle or a wound from an ingrown nail.
Symptoms: Symptoms often develop suddenly and include increased pain, redness, warmth, swelling, and sometimes the presence of pus.

Fungal Toenail Infection (Onychomycosis)

Causes: Fungi thrive in warm, moist environments and can enter through small cuts in the skin.
Symptoms: This type of infection typically develops gradually. Nails may become thick, brittle, and discolored (often yellow or brown), and may crumble at the edges or separate from the nail bed. Antibiotics are not effective against fungal infections.

Common Oral Antibiotics for Bacterial Toenail Infections

When a healthcare provider determines the infection is bacterial, they will prescribe an oral antibiotic targeting the most common pathogens. Here are some of the typical first-line and alternative options:

Cephalexin: A first-generation cephalosporin, cephalexin is a common choice for mild to moderate infections as it is effective against Staphylococcus aureus and streptococci. It is often prescribed for 7–10 days.
Clindamycin: This is an effective alternative for patients with a penicillin allergy, as it targets similar bacteria. Clindamycin is also useful for infections caused by oral anaerobes, which can occur from nail-biting.
Amoxicillin-Clavulanate (Augmentin): This broader-spectrum antibiotic may be considered for moderate infections or in specific patient populations, such as those with diabetes. It covers a range of Gram-positive, Gram-negative, and anaerobic bacteria.
Other options: For more severe cases or those with concerns about methicillin-resistant Staphylococcus aureus (MRSA), other antibiotics like trimethoprim-sulfamethoxazole (Bactrim) or doxycycline may be considered.

Topical Antibiotics: Effectiveness and Use

While oral antibiotics are needed for moderate to severe infections, topical antibiotics are generally insufficient for established bacterial paronychia because they cannot penetrate the nail bed effectively. For very mild cases, a topical treatment like mupirocin may be used, but this is usually paired with warm soaks and close monitoring. Over-the-counter antiseptic ointments can help reduce the risk of infection in minor scrapes but are not a substitute for prescription medication when an infection is present.

The Role of Comprehensive Treatment

Antibiotics alone are often not enough to clear a bacterial toenail infection, especially if the underlying cause is an ingrown nail. A comprehensive treatment plan is necessary for a full recovery.

Soaking: Soaking the affected foot in warm water with Epsom salt for 15-20 minutes, several times daily, can help reduce pain and inflammation. This can also aid in draining any pus that has collected.
Addressing the Ingrown Nail: The definitive treatment for an ingrown toenail infection often requires removing the ingrown portion of the nail. A podiatrist or physician may perform a partial or complete nail avulsion to allow for proper drainage and healing.
Footwear and Hygiene: Wearing loose-fitting, comfortable shoes that do not put pressure on the toe is vital. Maintaining proper foot hygiene, keeping the area clean and dry, is also crucial.

When to Seek Medical Care

It is essential to consult a doctor, especially if the infection is worsening or if you have an underlying health condition like diabetes. Seek immediate medical attention if you notice a fever, red streaks spreading away from the toe, or if the pain is so severe it affects your ability to walk. These can be signs of a more serious, spreading infection like cellulitis.

Comparison of Treatment Options for Infected Toenails


Treatment Type	When to Use	Advantages	Disadvantages
Oral Antibiotics	Confirmed bacterial infection (moderate-to-severe)	Targets the infection systemically, higher efficacy	Requires prescription, potential for side effects, not effective for fungal infections
Topical Antibiotics	Very mild, superficial infections only	Minimal systemic side effects	Insufficient for deeper infections, lower efficacy
Antifungal Medication	Confirmed fungal infection (onychomycosis)	Targets the specific fungal cause	Ineffective for bacterial infections, longer treatment times
Warm Soaks	Symptomatic relief, mild infections	Reduces pain and swelling, safe at-home remedy	Does not cure the bacterial infection alone
Nail Avulsion	When ingrown nail is causing infection	Removes the underlying cause, provides immediate relief	Surgical procedure, recovery time required

Conclusion

While a variety of treatments can address toenail issues, only prescription oral antibiotics can effectively treat a moderate-to-severe bacterial toenail infection (paronychia). Common choices include cephalexin and clindamycin, but the correct medication depends on factors only a healthcare provider can assess. Treatment should also include home care measures like warm soaks and addressing the root cause, such as an ingrown nail, often through a minor procedure. It is crucial to seek professional medical care for an accurate diagnosis and to avoid using antibiotics unnecessarily, which can contribute to antibiotic resistance. Medscape offers additional clinical information on the management of paronychia.

Frequently Asked Questions

Bacterial infections typically appear suddenly with noticeable symptoms like redness, warmth, swelling, and pus. Fungal infections, however, progress slowly and often cause the nail to become thick, brittle, or discolored.

For moderate to severe bacterial infections, over-the-counter topical creams are usually insufficient because they cannot penetrate the deeper infection. A doctor-prescribed oral antibiotic is typically needed for an established infection.

For an infected ingrown toenail, a healthcare provider may prescribe oral antibiotics like cephalexin or clindamycin, in addition to addressing the ingrown portion of the nail itself.

You should see a doctor if you experience severe pain, see pus or red streaks extending from the toe, have a fever, or have underlying conditions like diabetes that increase infection risk.

For individuals with a penicillin allergy, clindamycin is a common and effective alternative antibiotic used to treat bacterial toenail infections caused by susceptible bacteria.

Yes, soaking the affected foot in warm water with Epsom salt can help reduce pain, swelling, and inflammation. While it provides symptomatic relief, it is not a cure and should be used alongside professional medical advice.

Surgery may be necessary in severe cases or when the infection is caused by a persistent ingrown toenail. The procedure, typically performed by a podiatrist, involves removing part or all of the nail to allow proper healing.