What is the recommended antibiotic regimen and dosing for a 16-year-old female weighing 68kg with a puncture wound on her foot from a catfish barb in saltwater?

From the Guidelines

For a 16-year-old female weighing 68kg with a catfish barb puncture wound from saltwater, the recommended antibiotic regimen is ciprofloxacin 500mg orally twice daily for 5-7 days, as it provides coverage against Vibrio species and other marine organisms that can cause rapidly progressive infections 1. The wound should first be thoroughly cleaned with soap and water, and any visible debris removed. Some key points to consider in the management of this patient include:

• Immersing the affected area in hot water (as hot as can be tolerated without burning, approximately 110°F/43°C) for 30-90 minutes may help denature the heat-labile toxins often present in catfish stings.
• Catfish wounds in saltwater environments are particularly concerning due to potential infection with Vibrio species and other marine organisms.
• If signs of progressive infection develop (increasing redness, swelling, warmth, streaking, fever), immediate medical attention should be sought as more aggressive treatment including intravenous antibiotics may be necessary.
• Pain management with acetaminophen or ibuprofen is also appropriate. It's worth noting that the choice of antibiotic regimen should be based on the likely or proven causative pathogen(s) and their antibiotic susceptibilities, as well as other factors such as the clinical severity of the infection and the presence of patient-related factors 1. However, in this case, ciprofloxacin is a reasonable choice given its activity against Vibrio species and other marine organisms, and its relatively favorable side effect profile. Alternatively, trimethoprim-sulfamethoxazole (TMP-SMX) double strength (160mg/800mg) twice daily for 5-7 days can be used, although ciprofloxacin is generally considered a better option for this type of infection 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Antibiotic Regimen for Catfish Barb Puncture Wound

The recommended antibiotic regimen for a 16-year-old female weighing 68kg with a puncture wound on her foot from a catfish barb in saltwater is as follows:

• For moderate to severe infections, a combination of a tetracycline and a broad-spectrum, beta-lactamase-stable beta-lactam antibiotic, or a tetracycline, a beta-lactamase-stable penicillin, and an aminoglycoside may be used 2.
• Doxycycline and ceftazidime, or a fluoroquinolone (e.g., ciprofloxacin or levofloxacin) may be used to address common gram-positive and gram-negative aquatic bacteria in saltwater wounds 3.

Dosing Considerations

The dosing of antibiotics will depend on the specific medication and the patient's weight and renal function. It is essential to consult the prescribing information for each medication to determine the appropriate dose.

Key Points

• The patient should receive definitive wound care, including irrigation, exploration, and culture of the wound, as well as immunization against tetanus 2.
• Patients with hepatic disease or chronic illness and immunocompromised individuals are at high risk of fulminant infection due to Vibrio and Aeromonas species and should be treated with antibiotics after sustaining a water-associated wound 2.
• The choice of antibiotic should be based on the suspected or confirmed pathogens, as well as the patient's medical history and allergy status 3, 4.