From the Research
For a puncture wound through a shoe, the recommended antibiotic prophylaxis is amoxicillin-clavulanate (Augmentin) 875/125 mg orally twice daily for 5-7 days, as this regimen provides broad-spectrum coverage against common pathogens, including Pseudomonas aeruginosa, which is often associated with such injuries 1, 2. If the patient has a penicillin allergy, alternatives include trimethoprim-sulfamethoxazole (Bactrim DS) one tablet twice daily, doxycycline 100 mg twice daily, or levofloxacin 750 mg once daily, all for 5-7 days.
Importance of Antibiotic Prophylaxis
Antibiotic prophylaxis is particularly important for puncture wounds through shoes because these injuries carry a higher risk of infection due to both the deep nature of the wound and potential contamination from the shoe material. Pseudomonas aeruginosa is a common pathogen in these wounds, especially when the puncture occurs through a rubber-soled athletic shoe 2, 3.
Wound Management
Before starting antibiotics, the wound should be thoroughly cleaned, irrigated with sterile saline, and any foreign material or debris should be removed. This is crucial as rubber foreign bodies can lead to serious infective complications that resolve only with removal of all imbedded material 4. Tetanus prophylaxis should also be administered if the patient's immunization status is not up to date (within 5 years for dirty wounds) 5.
Patient Advice
The patient should be advised to elevate the affected limb, monitor for signs of infection (increasing pain, redness, swelling, warmth, drainage, or fever), and seek medical attention if these symptoms develop. Early recognition and management of infection are critical to preventing morbidity and mortality associated with puncture wounds through shoes. Given the potential for serious complications, including osteomyelitis, aggressive management, including surgical intervention if necessary, should be considered 1, 2.