Condition	Most common offending organisms	Recommended antimicrobial agents		Comments
Paronychia	Usually Staphylococcus aureus or streptococci; pseudomonas, gram-negative bacilli, and anaerobes may be present, especially in patients with exposure to oral flora	First-generation cephalosporin or anti-staphylococcal penicillin; if anaerobes or Escherichia coli are suspected, oral clindamycin (Cleocin) or a beta-lactamase inhibitor such as amoxicillin-clavulanate potassium (Augmentin)		Incision and drainage should be performed if infection is well established.
				If infection is chronic, suspect Candida albicans.
				Early infections without cellulites may respond to conservative therapy.
Felon	S. aureus, streptococci	First-generation cephalosporin or anti-staphylococcal penicillin		Incision and drainage should be performed if infection is well established.
				Oral antibiotic therapy usually is adequate.
Herpetic whitlow	Herpes simplex virus types 1 and 2	Supportive therapy		Antivirals may be prescribed if infection has been present for less than 48 hours.
				For recurrent herpetic whitlow, suppressive therapy with an antiviral agent may be helpful.
				Consider antibiotics if secondarily infected.
				Incision and drainage are contraindicated.
Pyogenic flexor tenosynovitis	S. aureus, streptococci, anaerobes	Parenteral first-generation cephalosporin or antistaphylococcal penicillin and penicillin G or Parenteral beta-lactamase inhibitor such as ampicillin-sulbactam (Unasyn) Use ceftriaxone (Rocephin) or a fluoroquinolone if Neisseria gonorrhoeae is suspected.		Early surgical assessment is suggested.
				N. gonorrhoeae or C. albicans should be suspected in sexually active or immunocompromised patients.
				Incision and drainage with catheter irrigation of the sheath should be performed if no improvement within the first 12 to 24 hours of conservative therapy.
Human bite, clenched-fist injury	S. aureus, streptococci, Eikenella corrodens, gram-negative bacilli, anaerobes	Parenteral first-generation cephalosporin or antistaphylococcal penicillin and penicillin G or Beta-lactamase inhibitor such as ampicillin-sulbactam or amoxicillin-clavulanate potassium or Second-generation cephalosporin such as cefoxitin (Mefoxin)		Prophylactic oral antibiotics should be used if outpatient therapy is chosen.
				Wounds should be explored, copiously irrigated, and surgically debrided.
				Hospitalization and parenteral antibiotics often are indicated.