From the Guidelines
For a hand cellulitis due to a puncture wound from a screwdriver injury, the antibiotic of choice is typically amoxicillin-clavulanate (Augmentin) 875/125 mg orally twice daily for 5-7 days. This recommendation is based on the likely organisms involved in this type of injury, which include both Staphylococcus aureus (including community-acquired methicillin-resistant S. aureus in some regions) and various environmental organisms that may have been on the screwdriver 1.
Key Considerations
- The wound should be thoroughly cleaned, and tetanus prophylaxis should be updated if needed.
- If MRSA is a significant concern in your area, consider adding trimethoprim-sulfamethoxazole (Bactrim) 1-2 double-strength tablets twice daily 1.
- For patients with penicillin allergy, clindamycin 300-450 mg orally four times daily is a reasonable alternative.
- If the infection appears severe with systemic symptoms, spreading rapidly, or involves deeper structures, intravenous antibiotics and surgical consultation may be necessary.
Rationale
The choice of antibiotic covers both gram-positive and gram-negative organisms commonly found in puncture wounds, and the addition of clavulanate helps overcome beta-lactamase resistance that might be present in some bacteria.
Additional Guidance
- Cultures from abscesses and other purulent SSTIs are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak 1.
- The duration of therapy should be individualized based on the patient’s clinical response, but a typical course is 5-7 days for uncomplicated cellulitis 1.
From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylocci Serious skin and soft tissue infections Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin
The antibiotic of choice for a hand cellulitis due to a puncture wound caused by a screwdriver injury is not directly stated in the label. However, clindamycin may be considered for the treatment of serious skin and soft tissue infections, including those caused by staphylococci and streptococci, which are common pathogens in such injuries.
- The choice of antibiotic should be guided by bacteriologic studies to determine the causative organisms and their susceptibility to clindamycin.
- In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy 2.
From the Research
Antibiotic Treatment for Hand Cellulitis
The antibiotic of choice for hand cellulitis due to a puncture wound caused by a screwdriver injury depends on the causative bacteria.
- The most common bacteria implicated in hand infections are Staphylococcus aureus and Streptococcus species 3.
- For uncomplicated superficial skin infections, amoxicillin-clavulanate offers the best guarantee of efficiency 4.
- In cases of allergy, a first-generation cephalosporin, a macrolide (if the susceptibility of the strain was checked), or pristinamycine (after 6 years of age) are acceptable alternatives 4.
- For dermohypodermitis, the bacterial antibiotic of choice remains amoxicillin-clavulanate, which is active against S. pyogenes, S. aureus, and anaerobic bacteria 4.
Considerations for Antibiotic Selection
- The use of topical antibiotics avoids the risk of systemic allergic reactions or generalized side effects and provides a high antibiotic concentration at the site of infection 5.
- When systemic therapy is indicated, the most commonly used agents for secondary skin infections are penicillinase-resistant semi-synthetic penicillins, first-generation cephalosporins, macrolides, and combination antibacterials, such as amoxicillin/clavulanate potassium and trimethoprim/sulfamethoxazole 5.
- Methicillin-resistant S aureus infections have become prevalent and represent a difficult problem, best treated with empiric antibiotic therapy until the organism can be confirmed 3.