What is the antibiotic (abx) of choice for a foot injury from stepping on an object 5 days ago, presenting with bleeding, tenderness, a hard central red area, and swelling?

From the Guidelines

For a foot injury from stepping on an object 5 days ago with bleeding, tenderness, a hard central red area, and swelling, the antibiotic of choice would be amoxicillin-clavulanate (Augmentin) 875/125 mg orally twice daily for 7-10 days, as suggested by the most recent guidelines 1. This is an appropriate first-line treatment because the presentation suggests a soft tissue infection that may have developed from the puncture wound, and the clinical signs indicate possible cellulitis. Amoxicillin-clavulanate provides good coverage against common skin and soft tissue pathogens including Staphylococcus aureus, Streptococcus species, and many anaerobes that might be present in a puncture wound.

Some key points to consider in the management of this patient include:

• The wound should be cleaned thoroughly to prevent further infection and promote healing.
• Tetanus prophylaxis should be considered if the patient's immunization status is not up to date, as tetanus is a potential complication of puncture wounds 1.
• If there is concern for a retained foreign body or if the infection worsens despite appropriate antibiotic therapy, imaging and surgical consultation may be necessary to assess for complications such as abscess formation or osteomyelitis 1.
• The hard central area could indicate an abscess formation, which might require incision and drainage in addition to antibiotics 1.
• For patients with penicillin allergy, alternatives include clindamycin 300-450 mg orally four times daily or trimethoprim-sulfamethoxazole (TMP-SMX) plus cephalexin, as these provide coverage against common pathogens in skin and soft tissue infections 1.
• The choice of antibiotic should be guided by the severity of the infection, the likely causative pathogens, and local resistance patterns, with consideration of the potential for antibiotic resistance and the need for antibiotic stewardship 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Presentation and Symptoms

• The patient presents with bleeding, tenderness, a hard central red area, and swelling 5 days after stepping on an object.
• These symptoms suggest a possible infection, which may be caused by a variety of bacteria, including Staphylococcus aureus 2.

Antibiotic Treatment

• The choice of antibiotic depends on the severity of the infection, the identity of the offending organism, and the patient's medical history 3, 4.
• For antibiotic-naive patients, high-dose flucloxacillin is recommended as the empirical antibiotic of choice 2.
• However, if the patient is suspected to have a methicillin-resistant Staphylococcus aureus (MRSA) infection, alternative antibiotics such as clindamycin, doxycycline, or linezolid may be considered 3.
• It is essential to note that the treatment should be guided by the results of tissue sampling and culture, and the choice of antibiotic should be narrowed down to a specific agent based on the identified organism 2.

Considerations

• The patient's vascular, neurologic, and immune status should be taken into account when selecting an antibiotic 4.
• The risk of adverse events, including the selection of resistant organisms, should also be considered when choosing an antibiotic 2.
• A multidisciplinary approach, including imaging modalities and deep tissue sampling, may be necessary to ensure accurate diagnosis and effective treatment 2.