From the Research
The typical treatment duration of antibiotics for flexor tenosynovitis is 7-14 days, with the exact length depending on the severity of infection and clinical response. Initial treatment usually involves intravenous antibiotics for 24-48 hours, followed by oral antibiotics to complete the course. Common antibiotic choices include cefazolin or oxacillin for methicillin-sensitive Staphylococcus aureus, or vancomycin for suspected methicillin-resistant Staphylococcus aureus (MRSA) 1. For oral continuation therapy, options include cephalexin 500mg four times daily, dicloxacillin 500mg four times daily, or clindamycin 300-450mg four times daily for MRSA coverage. Surgical drainage is often necessary alongside antibiotic therapy. Treatment should continue until all signs of infection have resolved, including pain, swelling, and erythema. The extended duration is necessary because tenosynovitis involves infection within the tendon sheath, which has relatively poor blood supply and requires longer antibiotic exposure to completely eradicate the infection and prevent recurrence or progression to deeper tissue involvement.
Some key points to consider when treating flexor tenosynovitis include:
- The use of oral postoperative antibiotic therapy with amoxicillin + clavulanic acid for 7-14 days appears to be effective, allowing for outpatient management 1
- The duration of postoperative antibiotic therapy (less than 7 days, between 7 and 14 days or more than 14 days) did not lead to any difference in healing rate, but treating for less than 7 days seemed to be associated with a higher risk of failure 1
- The use of outpatient oral antibiotics after surgical debridement for PFT does not significantly increase rates of readmission, repeat surgery, or amputation, except in cases with the involvement of surrounding structures 2
- Inpatient empirical IV antibiotic therapy can be considered for patients presenting with uncomplicated PFT, provided it is practiced under a hand specialist's surveillance 3
It's worth noting that the evidence suggests that the treatment duration and approach may vary depending on the severity of the infection and the presence of surrounding structure involvement. However, the most recent and highest quality study suggests that a treatment duration of 7-14 days is effective 1.