Antibiotic Regimen for Superficial Leg Laceration
Antibiotics are generally not indicated for simple superficial lacerations after proper wound cleansing and irrigation. 1, 2
Primary Treatment Approach
The cornerstone of managing superficial lacerations is mechanical wound care, not antibiotics:
- Thoroughly irrigate the wound with large volumes of warm or room temperature potable water (tap water or sterile saline) until all foreign matter and debris are removed 2, 3
- Cover with a clean occlusive dressing to maintain moisture and prevent contamination 2
- Ensure tetanus prophylaxis is current; administer if vaccination status is outdated or unknown 2
When Antibiotics Are NOT Needed
Most superficial lacerations do not require systemic antibiotics if properly cleaned and dressed 1, 2. Specifically:
- Clinically uninfected wounds should not receive antibiotic therapy 4
- There is little to no evidence supporting routine antibiotic use for simple wounds 4, 3
- Prophylactic antibiotics do not improve outcomes for most simple wounds 3
When to Consider Antibiotics
Consider oral antibiotics only if signs of infection develop, including 1, 2:
- Increasing pain, redness, swelling, or warmth
- Purulent discharge
- Fever or systemic symptoms
- Erythema extending >5 cm from wound edges with systemic signs (temperature >38.5°C or pulse >100 bpm) 4
Antibiotic Selection If Infection Develops
For mild-to-moderate spreading infections in patients without recent antibiotic exposure:
- Target aerobic gram-positive cocci only (streptococci and S. aureus) 4, 1
- Use highly bioavailable oral antibiotics such as cephalexin or dicloxacillin 1
- Consider empiric MRSA coverage (trimethoprim-sulfamethoxazole, doxycycline, or clindamycin) if patient has prior MRSA history, high local MRSA prevalence, or fails first-line therapy 4, 1
Duration of Therapy
- Mild infections: 1-2 weeks 1
- Continue antibiotics until resolution of infection signs, not through complete wound healing 4, 1
Common Pitfalls to Avoid
- Do not prescribe antibiotics for clean, uninfected wounds even in high-risk patients—this contributes to antibiotic resistance without benefit 4, 1
- Do not use antiseptic irrigation solutions—they provide no additional benefit over simple saline 4, 3
- Do not continue antibiotics through complete wound healing—stop when infection signs resolve 4, 1