From the Guidelines
Antibiotic coverage is generally recommended for fishhook injuries to the thumb in Florida, with a preferred treatment of a 5-7 day course of an antibiotic that covers both skin flora and water-borne organisms, such as amoxicillin-clavulanate (Augmentin 875/125mg twice daily) or doxycycline (100mg twice daily) 1. The choice of antibiotic should be based on the severity of the injury and the patient's medical history.
- Amoxicillin-clavulanate is a good option as it covers a wide range of bacteria, including streptococci, staphylococci, and anaerobes, as well as some gram-negative rods 1.
- Doxycycline is also a good option, particularly for its excellent activity against Pasteurella multocida, which is commonly found in animal bites, and its ability to cover some streptococci, although some streptococci are resistant 1. Before starting antibiotics, it is essential to thoroughly clean the wound with soap and water, remove any foreign material, and consider tetanus prophylaxis if the patient's immunization status is not up to date. Florida waters contain various bacteria, including Vibrio species, Aeromonas, and Mycobacterium marinum, that can cause serious infections, and the warm climate and brackish waters increase the risk of these infections 1. Patients should monitor for increasing pain, redness, swelling, or drainage, which may indicate worsening infection requiring medical reassessment. It is also important to note that the bacteriology of these wounds can differentiate the number of isolates per wound and whether additional coverage for anaerobes is required, and cultures are often not done on wounds, and empirical therapy might miss pathogens 1.
From the Research
Fishhook Injuries and Antibiotic Coverage
- Fishhook injuries are common among people who fish for recreation, and they can be encountered in anyone who has handled a fishhook 2.
- The management of fishhook injuries typically involves careful evaluation of the surrounding tissue, removal of the fishhook using various techniques, and wound care 3, 2, 4.
- Regarding antibiotic coverage, the evidence suggests that prophylactic antibiotics are generally not indicated for fishhook injuries 3.
- However, some studies recommend prophylactic antibiotics suitable for treatment of Aeromonas species to prevent complications, especially in cases where the fishhook is removed from a location with a high risk of infection 4.
- A retrospective analysis of fishhook injuries found that antibiotic prophylaxis did not change the outcome regardless of the fishhook location or the presence of an immunocompromising condition 5.
- The choice of antibiotic, if prescribed, may vary, with cephalexin being a common choice 5.
Specific Considerations for Florida
- There is no specific evidence to suggest that fishhook injuries in Florida require different management or antibiotic coverage compared to other locations.
- However, it is essential to consider the potential for exposure to freshwater pathogens, such as Aeromonas hydrophila, when managing fishhook injuries in Florida 5.
Wound Care and Follow-up
- Proper wound care, including extraction of foreign bodies and application of a simple dressing, is essential after fishhook removal 3.
- Tetanus status should be assessed, and toxoid administered if needed 3.
- Follow-up care may be necessary to monitor for complications, such as wound infections or abscess formation 5.