From the Guidelines
Antibiotic treatment for tenosynovitis is typically directed against the causative nontuberculous mycobacteria (NTM) species.
Causative Organisms
- The most common NTM species causing tenosynovitis include M. marinum and MAC (Mycobacterium avium complex), although M. fortuitum, M. abscessus, M. chelonae, and M. kansasii have also been implicated 1.
Treatment Approach
- Diagnosis is made by culture of the specific pathogen from drainage material or tissue biopsy, with tissue biopsy being the most sensitive means of obtaining a specimen for culture 1.
- Treatment should be guided by susceptibility testing and may involve a combination of antibiotics, although the specific regimen is not outlined in the provided evidence.
- It is essential to note that the treatment of NTM infections, including tenosynovitis, often requires prolonged antibiotic courses and may involve surgical intervention in some cases.
From the Research
Antibiotic Treatment for Tenosynovitis
- The use of antibiotics as a component of therapy for pyogenic flexor tenosynovitis has been shown to result in improved range of motion outcomes 2.
- Empiric antibiotic coverage should be directed toward staphylococci and streptococci, with consideration of patient characteristics and epidemiologic exposures to guide coverage for unusual causative organisms 3.
- Prompt administration of empirical intravenous antibiotics is a key component of management for pyogenic flexor tenosynovitis, often in combination with surgical treatment 4.
- The use of postoperative outpatient oral antibiotics has been compared to inpatient IV antibiotics, with one study finding no significant difference in rates of readmission, repeat surgery, or amputation, except in cases with involvement of surrounding structures 5.
Specific Antibiotic Regimens
- There is currently no standardized treatment algorithm for pyogenic flexor tenosynovitis, including the type and duration of antibiotic therapy 4.
- Local administration of antibiotics and/or corticosteroids has been shown to lessen morbidity from the infection in experimental animal studies, but additional research is required to confirm these findings in humans 6.
- The duration of antibiotic therapy has been varied, with one study reporting a duration of 13.1 +/- 9.9 days for oral antibiotics and 18.1 +/- 10.4 days for IV antibiotics 5.
Considerations for Antibiotic Use
- Patient characteristics, such as diabetes, and epidemiologic exposures should be considered when selecting antibiotic coverage 3, 5.
- The involvement of surrounding structures, such as felon, dorsal abscess, osteomyelitis, or septic arthritis, may impact the choice of antibiotic regimen and the need for more aggressive treatment 5.