Puncture Wounds - Outpatient

Notes

Prophylactic antibiotics are not routinely indicated in immunocompetent patients. Prescribe prophylaxis only if patient has risk factors for developing deep infection.

Risk Factors

Patient Risk Factors: advanced age, diabetes, immunocompromised 

Wound Risk Factors: penetrates muscle, injury through shoe, grossly contaminated, retained foreign body

Duration of therapy

Prophylaxis: 3 - 5 days

Mild-moderate infection: 5 - 7 days Consider 7-10 days if follow-up not available and/or multiple risk factors for developing deeper infection

First Line Regimens

Cephalexin shares structural side chains with penicillins. If PCN allergy, see below

OR

2nd Line OR Mild-Mod Penicillin Allergy or Intolerance

  • Does not share any structural side chains with penicillin or cephalexin

  • Note: non-formulary for inpatient/ED use. Prescribe for outpatient use only.

3rd Line OR Life-Threatening Penicillin and/or Ceph Allergy

  • Consider 450 mg PO QID if wt > 120 kg

  • Not routinely recommended due to poor Strep coverage in our region. Do not use unless cefuroxime contraindicated.

Puncture Through Sole of Shoe

If contraindication to FQ, choose antibiotics that empirically cover skin flora and stress importance of close monitoring and early follow-up with PCP

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