From the Guidelines
For a hand infection, empiric antibiotic therapy should typically include coverage for both Staphylococcus aureus and Streptococcus species, the most common causative organisms, with first-line treatment options including cephalexin, dicloxacillin, or amoxicillin-clavulanate for 7-10 days, as recommended by the Infectious Diseases Society of America 1.
Key Considerations
- The choice of antibiotic should be based on the severity of the infection and the suspected causative organisms.
- If MRSA is suspected, consider adding vancomycin or using alternative antibiotics such as clindamycin or trimethoprim-sulfamethoxazole.
- More severe infections may require intravenous antibiotics like cefazolin or vancomycin and possible surgical drainage.
- Along with antibiotics, elevate the affected hand, apply warm compresses, and ensure adequate pain control.
Treatment Options
- For mild to moderate infections:
- Cephalexin (500mg four times daily)
- Dicloxacillin (500mg four times daily)
- Amoxicillin-clavulanate (875/125mg twice daily)
- For severe infections or MRSA:
- Cefazolin
- Vancomycin
- Clindamycin (300-450mg three times daily)
- Trimethoprim-sulfamethoxazole (1-2 DS tablets twice daily)
Important Notes
- Seek immediate medical attention if there's rapid progression, red streaking up the arm, fever, or if the infection involves joints or tendons.
- The choice of antibiotic should be reassessed based on culture results when available, as targeting the specific pathogen improves outcomes and reduces the risk of antibiotic resistance, as noted in the guidelines 1.
From the FDA Drug Label
Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylocci Serious skin and soft tissue infections; Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin
Antibiotics for hand infection:
- Clindamycin can be used to treat serious skin and soft tissue infections, which may include hand infections, caused by susceptible bacteria such as streptococci, pneumococci, and staphylococci 2.
- However, bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin.
- Cephalexin may also be considered for the treatment of bacterial infections, but its use should be guided by culture and susceptibility information 3.
From the Research
Antibiotics for Hand Infection
- The choice of antibiotics for hand infections depends on the type of infection and the causative pathogen 4, 5, 6.
- Common bacteria implicated in hand infections include Staphylococcus aureus and Streptococcus species, with Methicillin-resistant S aureus (MRSA) being a significant concern 5, 6.
- For methicillin-susceptible S. aureus (MSSA) infections, penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) are the antibiotics of choice, while first generation cephalosporins (cefazolin, cephalothin and cephalexin) and clindamycin can be used for less serious infections 5.
- For MRSA infections, parenteral vancomycin or teicoplanin are recommended, with oral antimicrobials such as rifampicin and fusidic acid used in combination for multi-resistant strains 5.
- Cephalexin is an effective antibiotic for the treatment of streptococcal and staphylococcal skin infections, including those of the hand 7.
- Empiric antibiotics are often indicated for hand infections, particularly for deep infections such as pyogenic flexor tenosynovitis and clenched-fist bite wounds, and should be chosen in consultation with infectious disease specialists 6, 8.
Types of Hand Infections
- Superficial hand infections, such as paronychia and felon, can be managed with elevation, warm soaks, splinting, and empiric antibiotics when indicated 8.
- Deep hand infections, such as pyogenic flexor tenosynovitis and clenched-fist bite wounds, require prompt surgical consultation and empiric antibiotics to reduce long-term morbidity 8.
- The use of antibiotics such as cephalexin, clindamycin, and vancomycin may be necessary for the treatment of hand infections, depending on the causative pathogen and the severity of the infection 4, 5, 7.