From the Guidelines
For a hand infection, empiric antibiotic therapy should typically include coverage for both Staphylococcus aureus and Streptococcus species, with clindamycin (300-450mg three times daily for 7-10 days) or trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily for 7-10 days) being suitable options, especially if MRSA is suspected, as recommended by the Infectious Diseases Society of America guidelines 1.
Key Considerations
- The choice of antibiotic should be guided by the severity of the infection, the presence of systemic symptoms, and the likelihood of MRSA involvement.
- Incision and drainage of any abscess is crucial, alongside antibiotic therapy, for effective management of hand infections.
- It is essential to consider the potential for antibiotic resistance, particularly in cases where MRSA is suspected, and to choose antibiotics accordingly.
Antibiotic Options
- For mild to moderate infections, oral antibiotics such as clindamycin or trimethoprim-sulfamethoxazole may be sufficient.
- For more severe infections or those not responding to oral antibiotics, intravenous options like vancomycin may be necessary, especially if MRSA is suspected.
- The use of antibiotics should always be balanced with the risk of promoting antibiotic resistance and the potential for side effects.
Additional Management
- Proper wound care, including elevation of the affected hand, application of warm compresses, and meticulous hygiene, is vital.
- Patients should be advised to seek immediate medical attention if they experience worsening symptoms, such as increased pain, spreading redness, fever, or if the infection involves a joint or tendon, as hand infections can lead to serious complications if not promptly treated.
Evidence Base
The recommendations are based on guidelines from the Infectious Diseases Society of America 1, which provide a comprehensive approach to the diagnosis and management of skin and soft tissue infections, including those of the hand. These guidelines emphasize the importance of considering the causative pathogens, the severity of the infection, and the potential for antibiotic resistance when selecting antibiotic therapy.
From the Research
Antibiotics Used to Treat Hand Infections
- The choice of antibiotics for hand infections depends on the causative pathogen and its antibiotic sensitivity profile 2.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen in hand infections, and its resistance to clindamycin and levofloxacin has increased over time 2.
- For uncomplicated cellulitis, cephalexin plus trimethoprim-sulfamethoxazole may be considered as an alternative to cephalexin alone, although the difference in clinical cure rates was not statistically significant 3.
- Antibiotic stewardship is crucial in the treatment of hand infections, given the increasing rates of antibiotic resistance 4, 5.
- The treatment of hand infections should be guided by the results of culture and sensitivity tests, and empiric antibiotic therapy should be adjusted accordingly 2, 4.
Specific Antibiotics Mentioned
- Cephalexin: used to treat uncomplicated cellulitis, either alone or in combination with trimethoprim-sulfamethoxazole 3.
- Trimethoprim-sulfamethoxazole: used in combination with cephalexin to treat uncomplicated cellulitis, with potential benefits in terms of clinical cure rates 3.
- Clindamycin: its use is discouraged due to increasing resistance rates among MRSA isolates 2, 5.
- Levofloxacin: its use is also discouraged due to increasing resistance rates among MRSA isolates 2.