From the Research
For a glass injury to the foot, the recommended antibiotic treatment is amoxicillin-clavulanate 875/125 mg orally twice daily for 5-7 days, as it provides coverage for both skin flora and potential soil contaminants. This recommendation is based on the most recent and highest quality study available, which suggests that amoxicillin-clavulanate is effective in treating diabetic foot infections, a condition that shares similarities with glass injuries to the foot in terms of the risk of infection with gram-positive and gram-negative organisms 1.
Key Considerations
- The choice of antibiotic should be guided by the severity of the wound and the potential for contamination with soil or other materials.
- First-line treatment for uncomplicated wounds includes amoxicillin-clavulanate, with alternatives such as cephalexin plus metronidazole or clindamycin for patients with penicillin allergy.
- For more severe injuries, initial parenteral therapy with ceftriaxone plus metronidazole may be necessary.
- Antibiotics should be started after thorough wound cleaning, exploration for retained glass fragments, and proper debridement.
Rationale
The rationale for this coverage is that glass injuries can introduce both gram-positive organisms (Staphylococcus, Streptococcus) from skin and gram-negative or anaerobic bacteria if the glass was contaminated with soil or other materials. Tetanus prophylaxis should also be administered if the patient's immunization status is not up to date. Treatment duration may be extended to 10-14 days for established infections with signs of cellulitis or deeper tissue involvement.
Evidence Summary
While the provided studies primarily focus on diabetic foot infections, the principles of antibiotic treatment can be applied to glass injuries of the foot, considering the similar risk factors for infection 2, 3, 1, 4, 5. The most recent study from 2017 highlights the importance of considering the local microbial epidemiology and antibiotic sensitivity in guiding treatment decisions 1. However, the specific recommendation for amoxicillin-clavulanate is based on its broad-spectrum coverage and efficacy in treating skin and soft tissue infections, as supported by the available evidence.