From the Guidelines
The next step for a non-healing laceration on the foot treated with trimethoprim/sulfamethoxazole (TMP/SMX) is to consider changing the antibiotic to a broader-spectrum agent, such as ciprofloxacin 500mg twice daily or doxycycline 100mg twice daily for 7-10 days, as TMP/SMX may not provide adequate coverage for common foot pathogens such as Pseudomonas aeruginosa or Streptococcus species 1.
Key Considerations
- Ensure proper wound care, including debridement and dressing changes, to promote healing 1.
- If the laceration is deep or shows signs of abscess or osteomyelitis, consider consulting a specialist for further evaluation and management 1.
- Assess for any underlying conditions, such as diabetes, that may be contributing to the delayed healing 1.
Additional Recommendations
- Select an empirical antibiotic regimen based on the severity of the infection and the likely etiologic agent(s) 1.
- Consider providing empiric therapy directed against MRSA in patients with a prior history of MRSA infection or high local prevalence of MRSA colonization or infection 1.
- Definitive therapy should be based on the results of an appropriately obtained culture and sensitivity testing of a wound specimen as well as the patient’s clinical response to the empiric regimen 1.
From the Research
Non-Healing Laceration on the Foot Treated with Trimethoprim/Sulfamethoxazole (TMP/SMX)
There are no research papers provided that directly address the next step for a non-healing laceration on the foot treated with trimethoprim/sulfamethoxazole (TMP/SMX). The studies provided focus on the treatment of urinary tract infections and uncomplicated cellulitis.
Treatment of Urinary Tract Infections
- The effectiveness of ciprofloxacin in treating urinary tract infections caused by gram-negative organisms resistant to trimethoprim/sulfamethoxazole was evaluated in a study 2.
- A comparison of once-daily extended-release ciprofloxacin and conventional twice-daily ciprofloxacin for the treatment of uncomplicated urinary tract infection in women found that both regimens were effective and well-tolerated 3.
- A study comparing amoxicillin-clavulanate and ciprofloxacin for the treatment of uncomplicated cystitis in women found that ciprofloxacin was more effective than amoxicillin-clavulanate 4.
- A randomized trial comparing short-course ciprofloxacin, ofloxacin, or trimethoprim/sulfamethoxazole for the treatment of acute urinary tract infection in women found that all three regimens were effective and had similar efficacy 5.
Treatment of Uncomplicated Cellulitis
- A study evaluating the effect of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone on clinical cure of uncomplicated cellulitis found that the use of cephalexin plus trimethoprim-sulfamethoxazole did not result in higher rates of clinical resolution of cellulitis in the per-protocol analysis 6.