From the Research
For a 45-year-old female with a fishhook injury, I recommend against routine empiric antibiotic therapy, as the most recent and highest quality study 1 suggests that antibiotic prophylaxis for freshwater-associated fishhook injury does not change outcome regardless of fishhook location or presence of an immunocompromising condition.
Key Considerations
- Prior to starting any treatment, the wound should be thoroughly cleaned with soap and water, and the fishhook should be completely removed.
- Tetanus prophylaxis should be administered if the patient's vaccination status is not up-to-date (meaning no tetanus shot within 5 years for dirty wounds or 10 years for clean wounds).
- The wound should be monitored for signs of infection such as increasing redness, warmth, swelling, purulent drainage, or systemic symptoms like fever.
- If signs of infection develop or if the infection worsens, the patient should seek immediate medical attention as intravenous antibiotics may be necessary.
Antibiotic Therapy
- If antibiotic therapy is deemed necessary due to signs of infection, amoxicillin-clavulanate 875/125 mg orally twice daily for 5-7 days may be considered, as it covers a broad spectrum of bacteria that can be introduced into the wound, including Staphylococcus, Streptococcus, and gram-negative organisms.
- For patients with penicillin allergy, alternatives include trimethoprim-sulfamethoxazole DS (one tablet twice daily) plus clindamycin (300-450 mg three times daily) or doxycycline (100 mg twice daily).
Conclusion Not Applicable - Ongoing Care
Ongoing care should focus on wound monitoring and addressing any complications that may arise, rather than relying on routine antibiotic prophylaxis.