What is the best antibiotic for a hand wound?

Best Antibiotic for Hand Wounds

For hand wounds, amoxicillin-clavulanate is the first-line antibiotic choice, given orally at 875/125 mg twice daily for 7-10 days. 1

Rationale for Amoxicillin-Clavulanate

Hand wounds are particularly high-risk for serious infectious complications including septic arthritis, osteomyelitis, and tendonitis, making appropriate antibiotic selection critical. 1 The choice of amoxicillin-clavulanate is based on:

• Broad polymicrobial coverage: Hand wounds typically harbor mixed aerobic and anaerobic bacteria including Staphylococcus aureus, streptococci, and anaerobes. 1
• Proven efficacy: This combination has been specifically studied and recommended in clinical guidelines for hand wounds. 1
• Single-agent convenience: Provides comprehensive coverage without requiring multiple antibiotics. 1

Context-Specific Considerations

If Bite Wound (Animal or Human)

• Animal bites: Amoxicillin-clavulanate 875/125 mg twice daily remains first-line, covering Pasteurella multocida (75% of cat bites, 50% of dog bites) and anaerobes. 1
• Human bites: Same regimen covers Eikenella corrodens (present in 30% of human bites), streptococci, S. aureus, and oral anaerobes. 1

Alternative Regimens

For penicillin allergy:

• Doxycycline 100 mg twice daily PLUS metronidazole 250-500 mg three times daily 1
• Moxifloxacin 400 mg daily (monotherapy with anaerobic coverage) 1

Avoid these antibiotics as they have poor activity against key pathogens:

• First-generation cephalosporins (miss P. multocida and anaerobes) 1
• Clindamycin alone (misses P. multocida and E. corrodens) 1
• Macrolides like erythromycin (poor P. multocida activity) 1

If Traumatic Wound (Non-Bite)

• Clean wounds: First- or second-generation cephalosporin (cefazolin 1g IV every 8h or cephalexin 500mg orally three times daily) targeting S. aureus and streptococci. 1, 2
• Contaminated wounds: Amoxicillin-clavulanate for broader coverage. 1

Critical Management Points

Hand wounds require special attention because:

• Pain disproportionate to injury suggests periosteal penetration requiring prolonged therapy (4-6 weeks for osteomyelitis, 3-4 weeks for synovitis). 1
• Early elevation of the injured hand accelerates healing. 1
• Follow-up within 24 hours is mandatory. 1

Antibiotic timing:

• Start antibiotics as soon as possible—delays beyond 3 hours increase infection risk. 1
• For fresh wounds (<24 hours), treat for 7-10 days. 1
• Do not give antibiotics if presenting ≥24 hours post-injury without signs of infection. 1

Intravenous Options for Severe Infections

If hospitalization required (severe infection, immunocompromised host, failed outpatient therapy):

• Ampicillin-sulbactam 1.5-3.0g IV every 6-8 hours 1
• Piperacillin-tazobactam 3.37g IV every 6-8 hours 1
• Carbapenems (ertapenem 1g daily, imipenem 1g every 6-8h) 1

Note: All IV options miss MRSA; add vancomycin if MRSA suspected. 1

Essential Adjunctive Measures

Beyond antibiotics, proper wound management is equally important:

• Cleanse with sterile normal saline (avoid iodine or antibiotic solutions). 1
• Do not close infected wounds. 1
• Ensure tetanus prophylaxis is current. 1