What are the intravenous (IV) antibiotics for hand infections?

From the Guidelines

Intravenous antibiotics for hand infections should include vancomycin (30 mg/kg/d in 2 divided doses IV) as the primary agent to cover MRSA, with consideration of adding a gram-negative coverage agent such as piperacillin-tazobactam or cefepime, 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, with vancomycin being the preferred agent for MRSA coverage.
• For less severe infections, cefazolin (1-2g every 8 hours IV) may be considered as an alternative, especially in patients with a low risk of MRSA infection.
• The addition of a gram-negative coverage agent should be based on the clinical presentation and risk factors for gram-negative infection.
• Treatment duration should be individualized based on clinical response, with a typical range of 5-14 days.

Antibiotic Options

• Vancomycin: 30 mg/kg/d in 2 divided doses IV, as recommended for MRSA coverage 1.
• Cefazolin: 1-2g every 8 hours IV, for less severe infections or as an alternative to vancomycin.
• Piperacillin-tazobactam or cefepime: may be added for gram-negative coverage, depending on the clinical presentation and risk factors.

Important Notes

• Surgical drainage is often necessary for abscesses or deep space infections, and should be performed in conjunction with antibiotic therapy.
• Culture results should be obtained before starting antibiotics when possible, to guide antibiotic selection and adjustment.
• Patients should be monitored for clinical improvement within 48-72 hours, with antibiotic adjustments made if response is inadequate.

From the FDA Drug Label

In pediatric patients, a total daily dosage of 25 to 50 mg/kg (approximately 10 to 20 mg/lb) of body weight, divided into 3 or 4 equal doses, is effective for most mild to moderately severe infections. The desired dose diluted in this manner should be administered by intermittent IV infusion over a period of at least 60 minutes.

The intravenous (IV) antibiotics for hand infections are:

• Cefazolin (IV): effective for most mild to moderately severe infections, with a total daily dosage of 25 to 50 mg/kg of body weight, divided into 3 or 4 equal doses.
• Vancomycin (IV): administered by intermittent IV infusion over a period of at least 60 minutes, with a dose that should be diluted in at least 100 mL of a suitable infusion solution 2 3.

From the Research

Intravenous (IV) Antibiotics for Hand Infections

• The choice of IV antibiotics for hand infections depends on various factors, including the type of infection, the causative pathogen, and the patient's medical history 4, 5, 6.
• For severe hand infections, such as pyogenic flexor tenosynovitis, parenteral antibiotics are often required, and the choice of antibiotic should be guided by the results of culture and sensitivity testing 4.
• Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen in hand infections, and antibiotic resistance patterns should be considered when selecting empiric therapy 5, 6.
• Clindamycin and levofloxacin are commonly used antibiotics for hand infections, but resistance to these agents is increasing, and alternative antibiotics may be necessary in some cases 5, 6.
• The use of IV antibiotics in combination with other treatments, such as surgical intervention and wound care, may be necessary to effectively manage hand infections 4, 7.

Specific Antibiotic Recommendations

• There is no specific recommendation for a single IV antibiotic for hand infections, as the choice of antibiotic depends on various factors, including the type of infection and the causative pathogen 4, 5, 6.
• However, antibiotics such as vancomycin, linezolid, and daptomycin may be effective against MRSA and other antibiotic-resistant pathogens 5, 6.
• The selection of IV antibiotics should be guided by the results of culture and sensitivity testing, as well as the patient's medical history and other factors 4, 5, 6.