From the Guidelines
For treating flexor tenosynovitis, the recommended antibiotics typically include a combination of intravenous cefazolin (1-2g every 8 hours) plus either gentamicin (5mg/kg daily) or ciprofloxacin (400mg every 12 hours), as supported by the Infectious Diseases Society of America guidelines 1. This combination provides coverage against common causative organisms including Staphylococcus aureus, Streptococcus species, and gram-negative bacteria.
- The choice of antibiotics should be based on the severity of the infection and the presence of risk factors for MRSA.
- For patients with MRSA risk factors, vancomycin (15-20mg/kg every 12 hours) should replace cefazolin, as recommended by the Infectious Diseases Society of America guidelines 1.
- Treatment usually begins with IV antibiotics for 24-48 hours, followed by oral antibiotics such as cephalexin (500mg four times daily) or amoxicillin-clavulanate (875/125mg twice daily) for a total duration of 10-14 days.
- Antibiotic therapy should be adjusted based on culture results when available, as suggested by the WHO's essential medicines and aware recommendations 1. It's essential to note that antibiotic treatment alone is often insufficient; surgical drainage is typically necessary alongside antibiotics for purulent tenosynovitis.
- Early treatment is crucial to prevent complications such as tendon necrosis, adhesions, or loss of hand function.
- Patients should be monitored closely for clinical improvement, with consideration for infectious disease consultation in complicated cases or those not responding to initial therapy, as recommended by the Infectious Diseases Society of America guidelines 1.
From the Research
Antibiotic Recommendations for Flexor Tenosynovitis
The recommended antibiotics for treating flexor tenosynovitis are:
- Amoxicillin + clavulanic acid for 7-14 days, as suggested by 2
- Penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) for methicillin-susceptible S. aureus (MSSA) infections, as stated in 3
- Vancomycin or teicoplanin for serious methicillin-resistant S. aureus (MRSA) infections, as recommended in 3
- Lincosamides (clindamycin, lincomycin) or cotrimoxazole for less serious non-multiresistant MRSA infections, as suggested in 3
Considerations for Antibiotic Treatment
When choosing an antibiotic, consider the following:
- The type of bacteria causing the infection, as different antibiotics are effective against different types of bacteria 3
- The severity of the infection, as more severe infections may require more aggressive treatment 2
- The patient's medical history and potential allergies, as certain antibiotics may be contraindicated in patients with certain conditions or allergies 3
Non-Surgical Management with Antibiotics
In some cases, flexor tenosynovitis can be treated non-surgically with antibiotics, immobilization, and elevation, as shown in 4