What antibiotic covers a deep wound?

Antibiotic Selection for Deep Wounds

For deep wounds, amoxicillin-clavulanate or ampicillin-sulbactam are the first-line antibiotics of choice due to their broad-spectrum coverage of common pathogens including aerobic and anaerobic organisms. 1

First-Line Antibiotic Options

• Amoxicillin-clavulanate (875/125 mg twice daily orally) is the preferred first-line option for deep wounds due to its excellent coverage of common skin pathogens, including Staphylococcus aureus, streptococci, and anaerobes 2, 1
• Ampicillin-sulbactam (1.5-3.0 g every 6 hours intravenously) is an equivalent alternative for patients requiring parenteral therapy 2
• These agents provide coverage against both aerobic and anaerobic organisms commonly found in deep wound infections 2

Alternative Options Based on Clinical Scenario

• For patients with penicillin allergy, consider:

  • Moxifloxacin (400 mg daily) as it provides good monotherapy coverage including anaerobes 2
  • Combination of ciprofloxacin (500-750 mg twice daily) plus metronidazole (250-500 mg three times daily) 2
  • Clindamycin (300 mg three times daily) for good coverage against staphylococci, streptococci, and anaerobes 2

• For suspected or confirmed MRSA infections:

  • Sulfamethoxazole-trimethoprim (160-800 mg twice daily) 1
  • Doxycycline (100 mg twice daily) with good activity against Eikenella species, staphylococci, and anaerobes 2

Special Considerations

• For deep wounds with systemic signs of infection, compromised immune status, or severe comorbidities, broad-spectrum antibiotics effective against both aerobic and anaerobic organisms are required 2
• Irrigation of the wound and debridement of necrotic tissue are essential components of treatment and can substantially decrease the incidence of invasive wound infection 2
• Tetanus prophylaxis should be administered to patients without toxoid vaccination within the past 10 years 2

Common Pitfalls to Avoid

• Delaying antibiotic administration beyond 3 hours post-injury significantly increases infection risk in traumatic wounds 1, 3
• Failing to obtain cultures before starting antibiotics in complex or severe infections can lead to inadequate coverage 1
• Continuing antibiotics beyond recommended duration without evidence of ongoing infection increases risk of resistance 1
• Primary wound closure is not recommended for deep wounds except for facial wounds, which should be managed with copious irrigation, cautious debridement, and preemptive antibiotics 2

Antibiotic Selection Algorithm

1. Assess wound severity and patient risk factors:

   • For mild to moderate infections: Amoxicillin-clavulanate or ampicillin-sulbactam 1
   • For severe infections: Consider broader coverage with addition of agents for resistant organisms 2

2. Consider local resistance patterns:

   • In areas with high MRSA prevalence, add MRSA coverage with sulfamethoxazole-trimethoprim or doxycycline 1

3. Evaluate for special circumstances:

   • For human or animal bites: Amoxicillin-clavulanate or ampicillin-sulbactam are specifically recommended 1
   • For diabetic wound infections: Options include dicloxacillin, clindamycin, cefalexin, levofloxacin, amoxicillin-clavulanate, or doxycycline 1