What is the best antibiotic to give for a laceration (lac) repair caused by wood?

Amoxicillin-Clavulanate is the Best Antibiotic for Laceration Repair from Wood Injury

For laceration repair caused by wood, amoxicillin-clavulanate (875/125 mg twice daily) is the recommended antibiotic of choice due to its coverage of both aerobic and anaerobic bacteria commonly found in wood-contaminated wounds. 1

Rationale for Antibiotic Selection

• Wood-contaminated wounds are considered high-risk for infection due to the presence of both aerobic and anaerobic bacteria, requiring broad-spectrum coverage 1
• Amoxicillin-clavulanate provides excellent coverage against common pathogens in wood injuries, including:
  • Staphylococcus species
  • Streptococcus species
  • Pasteurella multocida
  • Anaerobic bacteria including Fusobacterium species 1
• The Infectious Diseases Society of America (IDSA) specifically recommends amoxicillin-clavulanate for contaminated wounds similar to animal bites due to similar microbial profiles 1

Dosing and Duration

• Oral amoxicillin-clavulanate: 875/125 mg twice daily 1
• Duration: Typically 3-5 days depending on wound severity and clinical response 1
• For severe contamination or immunocompromised patients, consider extending treatment up to 7 days 1

Alternative Options

If patient has penicillin allergy, consider these alternatives:

• Moderate penicillin allergy: Doxycycline 100 mg twice daily 1
• Severe penicillin allergy: Combination therapy with:
  • Clindamycin 300-450 mg three times daily (for anaerobic coverage) 1, 2
  • PLUS either trimethoprim-sulfamethoxazole or a fluoroquinolone (for aerobic coverage) 1

Special Considerations

• Tetanus prophylaxis: Administer tetanus toxoid if vaccination not current within 10 years. Tetanus, diphtheria, and pertussis (Tdap) is preferred if not previously given 1
• Wound care: Thorough irrigation and debridement are essential components of treatment alongside antibiotic therapy 3
• Timing: No definitive "golden period" exists for wound closure; depending on contamination level, wounds may be safely closed even 18+ hours after injury 3

Monitoring and Follow-up

• Assess for signs of infection within 48-72 hours of initiating therapy 4
• Signs of treatment failure requiring reassessment:
  • Increasing pain, erythema, or swelling
  • Purulent drainage
  • Systemic symptoms (fever, chills) 1

Evidence Quality Assessment

• The recommendation for amoxicillin-clavulanate is based on strong evidence from IDSA guidelines (2014) 1
• Limited high-quality studies specifically address wood-contaminated wounds, but the microbial profile is similar to animal bites, for which stronger evidence exists 1
• Studies examining antibiotic prophylaxis for simple lacerations show variable infection rates (1-10%), supporting the need for prophylaxis in contaminated wounds 5, 6

Common Pitfalls

• Inadequate debridement and irrigation of the wound, which are essential regardless of antibiotic choice 3
• Using narrow-spectrum antibiotics that fail to cover anaerobes in wood-contaminated wounds 1
• Failure to assess for retained foreign bodies (wood splinters), which can lead to persistent infection despite appropriate antibiotic therapy 1
• Overlooking tetanus prophylaxis, which is critical in contaminated wounds 1