From the Research
For stab wounds, the best antibiotic regimen is typically a broad-spectrum agent that covers both gram-positive and gram-negative bacteria, as well as anaerobes if deep tissue or abdominal involvement is suspected, with piperacillin/tazobactam being a suitable option as it has been shown to effectively penetrate wounds during negative pressure wound therapy 1. The choice of antibiotics should be based on the severity and location of the wound, as well as the patient's overall health status and potential allergies. Some key considerations include:
- Coverage of skin flora, including Staphylococcus aureus
- Coverage of gram-negative bacteria and anaerobes in contaminated or high-risk wounds
- Use of combination therapy, such as cefazolin plus metronidazole, for enhanced coverage
- Alternative options, such as clindamycin, for penicillin-allergic patients
- Duration of antibiotic therapy, ranging from 24 hours for prophylaxis to 5-14 days for established infections
- Initiation of antibiotics as soon as possible after injury, ideally within 3 hours
- Importance of proper wound management, including thorough cleaning, debridement, and surgical exploration, as well as tetanus prophylaxis if necessary It's also important to note that the most recent study 2 suggests that ceftriaxone may be a viable alternative to cefazolin for the treatment of methicillin-susceptible Staphylococcus aureus bacteraemia, but this may not be directly applicable to the treatment of stab wounds. Additionally, a study from 2016 3 compared cefazolin plus gentamicin to piperacillin/tazobactam for antibiotic prophylaxis in patients with type 3 open fractures and found similar rates of surgical site infection, nonunion, mortality, and rehospitalization at 1 year. However, the study from 2017 1 provides more relevant information for the treatment of stab wounds, as it evaluated the wound penetration of antibiotics during negative pressure wound therapy.