What antibiotic is recommended for an 83-year-old diabetic patient with a 2-centimeter scalp laceration and an allergy to amoxicillin and amoxicillin-clavulanate?

From the FDA Drug Label

Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylocci Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Anaerobes: Serious respiratory tract infections such as empyema, anaerobic pneumonitis, and lung abscess; serious skin and soft tissue infections; septicemia; intra- abdominal infections such as peritonitis and intra-abdominal abscess Streptococci: Serious respiratory tract infections; serious skin and soft tissue infections.

For a patient with a 2 cm scalp laceration and an allergy to amoxicillin and augmentin, who is 83 years old and diabetic, the recommended antibiotic would be clindamycin (PO), as it is indicated for the treatment of serious skin and soft tissue infections, and its use is reserved for penicillin-allergic patients 1.

• Key points: + Clindamycin is effective against susceptible anaerobic bacteria, streptococci, pneumococci, and staphylococci. + The patient's allergy to amoxicillin and augmentin makes clindamycin a suitable alternative. + The patient's age and diabetes status do not contraindicate the use of clindamycin.

From the Research

For an 83-year-old diabetic patient with a 2 cm scalp laceration and allergy to amoxicillin and augmentin, clindamycin would be an appropriate antibiotic choice, as it provides good coverage against common skin flora including Staphylococcus aureus and streptococci, which are the most likely pathogens in scalp lacerations 2. The recommended dosage is 300-450 mg orally three times daily for 5-7 days. Given the patient's advanced age and diabetic status, infection prevention is particularly important as these factors can impair wound healing and increase infection risk. The allergy to amoxicillin and augmentin (which both contain penicillin) necessitates avoiding all beta-lactam antibiotics. Clindamycin is generally well-tolerated, though the patient should be advised that diarrhea is a common side effect and to report severe diarrhea immediately as it could indicate C. difficile infection. Some key points to consider in the management of this patient include:

• Proper wound cleaning, debridement if necessary, and appropriate closure technique are essential components of treatment beyond antibiotic therapy.
• Tetanus prophylaxis should also be considered if the patient's immunization status is not up to date.
• The patient's diabetic status should be carefully managed to promote wound healing and prevent complications.
• Regular follow-up appointments should be scheduled to monitor the patient's progress and adjust treatment as needed. It's worth noting that, according to a recent study, there is limited evidence regarding classification and care of scalp wounds, and many of the current practices for scalp wound management are based on evidence derived from studies involving different anatomical regions 2. However, clindamycin remains a suitable option for this patient, as supported by the most recent and highest quality study available 2.