From the Guidelines
The treatment of a felon requires prompt medical attention, typically involving both antibiotics and surgical drainage, with the cornerstone of treatment being surgical drainage to prevent complications like osteomyelitis or permanent damage to the fingertip. For initial treatment, oral antibiotics such as clindamycin, trimethoprim-sulfamethoxazole, or a tetracycline (doxycycline or minocycline) may be considered for empirical coverage of CA-MRSA, as recommended by the Infectious Diseases Society of America 1. The choice of antibiotic should be individualized based on the patient's clinical response and pending culture results.
Key Considerations
- Surgical drainage should be performed as soon as possible to prevent complications, and the procedure involves making an incision over the area of maximum tenderness, typically on the pad of the finger but avoiding the central area to prevent scarring and sensory loss 1.
- After drainage, the wound should be packed with sterile gauze and changed daily, and warm water soaks for 15 minutes 3-4 times daily can help with pain and promote healing.
- Pain management with acetaminophen or NSAIDs is usually sufficient, and elevation of the affected hand above heart level reduces swelling and pain.
- 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.
Antibiotic Therapy
- For empirical coverage of CA-MRSA in outpatients with SSTI, oral antibiotic options include clindamycin, trimethoprim-sulfamethoxazole, a tetracycline (doxycycline or minocycline), and linezolid 1.
- If coverage for both b-hemolytic streptococci and CA-MRSA is desired, options include clindamycin alone, or trimethoprim-sulfamethoxazole or a tetracycline in combination with a b-lactam (eg, amoxicillin), or linezolid alone 1.
- The duration of antibiotic therapy should be individualized based on the patient's clinical response, but typically ranges from 5-10 days for outpatients with purulent or nonpurulent cellulitis, and 7-14 days for hospitalized patients with complicated SSTI 1.
From the Research
Treatment Options
- Amoxicillin is a broad-spectrum antibiotic used to treat various infections, including those of the ear, nose, and throat, genitourinary tract, skin, and lower respiratory tract 2.
- Amoxicillin-clavulanate (Augmentin) is a combination of amoxicillin and clavulanic acid, used to treat community-acquired respiratory tract infections, including those caused by beta-lactamase-producing bacteria 3.
Efficacy and Safety
- Amoxicillin and amoxicillin-clavulanate have been shown to be effective in treating various infections, including community-acquired respiratory tract infections 3, 4.
- The safety and tolerance profile of amoxicillin-clavulanate is well-known, with a low propensity to select resistance mutations 3.
- High-dose formulations of amoxicillin-clavulanate have been developed to treat drug-resistant pathogens, such as Streptococcus pneumoniae with reduced susceptibility to penicillin 3.
Dosage and Administration
- The dosage and administration of amoxicillin and amoxicillin-clavulanate depend on various factors, including the site of infection, pharmacokinetics, and pharmacodynamic targets 5.
- Different combination ratios of amoxicillin and clavulanic acid are available, with varying maximum daily doses of amoxicillin due to the limitations imposed by clavulanic acid's side effects 6.
Indications and Usage
- Amoxicillin and amoxicillin-clavulanate are indicated for the treatment of various infections, including community-acquired respiratory tract infections, skin and soft tissue infections, and urinary tract infections 3, 6.
- The choice between amoxicillin and amoxicillin-clavulanate depends on the specific infection being treated, with amoxicillin alone often preferred for certain indications 6.