From the Guidelines
For this patient with a hand infection, I recommend administering cephalexin 500mg orally twice daily for 7 days to treat the bacterial infection, as supported by the Infectious Diseases Society of America's 2014 guidelines 1. The treatment plan should also include prednisone 20mg orally once daily for 5 days to reduce inflammation, and cetirizine (Zyrtec) daily for 5 days to help manage allergic symptoms. Key aspects of the treatment plan include:
- Taking all medications with food to minimize gastrointestinal side effects
- Applying cold compresses to the affected area for 15-20 minutes several times daily
- Elevating the hand when possible to reduce swelling
- Keeping the area clean and dry, avoiding tight bandages which could restrict circulation
- Monitoring closely for warning signs including increased pain, swelling, red streaking up the arm, fever, or decreased finger mobility
- Seeking emergency care immediately if these symptoms develop or if the patient experiences difficulty breathing, widespread rash, or facial swelling, which could indicate a severe allergic reaction The choice of cephalexin is based on its effectiveness against Staphylococcus aureus, a common cause of skin and soft tissue infections, as recommended by the guidelines 1. Completing the full antibiotic course even if symptoms improve is crucial to prevent recurrence or antibiotic resistance. Follow-up with a healthcare provider in 2-3 days to ensure improvement, or sooner if symptoms worsen, is also essential to monitor the patient's progress and adjust the treatment plan as needed.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Plan
The treatment plan involves administering cephalexin 500mg by mouth twice daily for 7 days to treat potential infection, and prednisone 20mg by mouth once daily for 5 days to reduce inflammation.
- Give all medications with food to minimize stomach upset.
- Continue cold compresses for 15-20 minutes several times daily and elevate the affected hand when possible.
- Zyrtec/cetirizine daily x 5 days.
- Keep the area clean and dry, avoiding tight bandages.
Monitoring and Follow-up
Watch for worsening symptoms including:
- Increased pain
- Swelling
- Red streaking up the arm
- Fever
- Difficulty moving the finger Go to the ER immediately if these occur or if your child develops:
- Difficulty breathing
- Widespread rash
- Facial swelling Complete the full course of antibiotics even if symptoms improve. Follow up in 2-3 days to ensure improvement, or sooner if concerned.
Rationale
The distinction between inflammation and infection is crucial, as noted in 2, where inflammation is defined as the body's response to a potentially damaging stimulus, and infection involves tissue invasion by microorganisms. The use of cephalexin twice daily is supported by 3, which found no statistically significant difference in treatment failure rates between patients prescribed cephalexin twice daily versus four times daily for the treatment of urinary tract infections. The addition of anti-inflammatory drugs, such as prednisone, may be beneficial in reducing inflammation, as discussed in 4, which highlights the importance of resolving inflammation and infection. However, the use of anti-inflammatory drugs as potential antimicrobial agents is still being explored, as noted in 5, which reviews the antimicrobial properties of various anti-inflammatory drugs. The treatment of cellulitis with cephalexin, with or without trimethoprim-sulfamethoxazole, is discussed in 6, which found no significant difference in treatment outcomes between the two groups.