What is the treatment for an infected hand injury?

Treatment of Infected Hand Injuries

The treatment of infected hand injuries requires prompt wound cleansing, appropriate antibiotic therapy, and in many cases, surgical drainage to prevent complications such as septic arthritis, osteomyelitis, or tendon damage.

Initial Assessment and Management

Wound Cleansing

• Clean the infected area thoroughly with sterile normal saline 1
• Remove superficial debris but avoid aggressive debridement that might enlarge the wound 1
• For visibly soiled wounds, use antimicrobial soap and water rather than alcohol-based hand rubs 1

Surgical Intervention

• Surgical drainage is necessary for most hand infections with abscess formation 2
• Immediate surgical consultation is required if there are signs of:
  • Abscess formation
  • Progression of infection
  • Lack of improvement within 72 hours of antibiotic therapy 3

Antibiotic Therapy

Empiric Antibiotic Selection

• For mild to moderate infections, amoxicillin-clavulanate 875/125 mg twice daily orally for 5-6 days is recommended as first-line therapy 3
• Alternative oral options include:
  • Cephalexin 500 mg 3-4 times daily 3
  • Clindamycin 300-450 mg orally three times daily 3

For Severe Infections

• Intravenous options include:
  • Ampicillin-sulbactam
  • Piperacillin-tazobactam
  • Cefazolin 1 g every 8 hours IV 3
  • For severe infections: vancomycin plus either piperacillin-tazobactam or a carbapenem 1, 3

Special Considerations

• For animal bite wounds: amoxicillin-clavulanate is preferred due to coverage against Pasteurella multocida 1
• For human bite wounds: consider coverage for anaerobes, which are present in 43% of human bite wounds 4
• For MRSA risk: add coverage if risk factors present (prior MRSA infection, injection drug use, etc.) 3

Duration of Therapy

• Standard duration: 5-7 days for uncomplicated infections 3
• Extend treatment if infection has not improved within 5 days 3
• Longer courses required for complications:
  • Septic arthritis: 3-4 weeks
  • Osteomyelitis: 4-6 weeks 1

Supportive Care

• Elevate the affected hand to reduce edema and accelerate healing 1, 3
• Immobilize the hand if necessary to reduce pain and prevent further tissue damage
• Monitor for signs of deeper infection or complications daily for the first 48-72 hours 3

Indications for Hospitalization

• Systemic inflammatory response syndrome (SIRS)
• Altered mental status
• Hemodynamic instability
• Concern for deeper or necrotizing infection
• Poor medication adherence
• Failure of outpatient therapy 3

Prevention of Recurrence

• Maintain good skin hygiene
• Promptly treat minor skin breaks to prevent infection 3
• For patients with recurrent infections, address underlying conditions (e.g., diabetes, immunosuppression)

Common Pitfalls to Avoid

• Delaying surgical drainage when indicated
• Using first-generation cephalosporins alone for animal or human bite wounds (poor coverage against P. multocida) 1
• Failing to elevate the affected extremity
• Inadequate duration of antibiotics, especially for deep space infections
• Not recognizing signs of necrotizing infection requiring urgent surgical intervention

Hand infections require aggressive management due to the potential for serious complications affecting hand function. The combination of appropriate antibiotics, surgical intervention when indicated, and supportive care is essential for optimal outcomes.