When to use antibiotics for a fish hook (foreign body) injury?

From the Guidelines

Antibiotics are generally not needed for most fish hook injuries unless there are specific risk factors or signs of infection. For uncomplicated fish hook injuries, proper wound cleaning with soap and water, followed by application of an antiseptic solution, is usually sufficient 1. However, prophylactic antibiotics should be considered for high-risk wounds, including deep punctures, contaminated wounds, delayed presentation, foreign body retention, or in immunocompromised patients.

Key Considerations

• The decision to use antibiotics should be based on the individual risk factors of the patient and the wound characteristics, rather than a universal approach 1.
• Early antibiotic treatment for 3 to 5 days may be recommended for fresh, deep wounds and wounds in certain critical bodily areas, such as hands, feet, areas near joints, face, and genitals 1.
• Antibiotics should not be given if the patient presents 24 h or more after the injury and there are no clinical signs of infection 1.

Antibiotic Options

• When antibiotics are indicated, first-line options may include amoxicillin-clavulanate or doxycycline for 5-7 days 1.
• For marine water exposures, consider coverage for Vibrio species with ciprofloxacin for 5-7 days.

Rationale

• The rationale for selective antibiotic use is that most properly cleaned fish hook injuries heal well without antibiotics, while unnecessary antibiotic use contributes to resistance 1.
• Regardless of antibiotic use, tetanus prophylaxis should be updated if needed, and the wound should be monitored for signs of infection, including increasing pain, redness, swelling, warmth, pus, or red streaking.

Wound Care

• Proper wound cleaning and care are essential to prevent infection and promote healing 1.
• Surgical treatment, such as debridement, may be necessary in some cases to remove necrotic tissue and reduce the burden of pathogens 1.

From the Research

Antibiotic Use for Fish Hook Foreign Body

• Prophylactic antibiotics are generally not indicated for fish hook injuries, as stated in the study by 2.
• A retrospective analysis by 3 found that antibiotic prophylaxis for freshwater-associated fish hook injury did not change outcome, regardless of fish hook location or presence of an immunocompromising condition.
• However, the study by 4 suggests that amoxicillin and clavulanic acid may be an adequate first-line antibiotic for fish spike injuries, but flucloxacillin may be more appropriate given that most bacteria were from patients' own skin flora.

Specific Considerations

• The study by 3 found that oral antibiotics were prescribed to 51% of patients with fish hook injuries, with cephalexin being the most common choice.
• The study by 4 found that 12% of patients with fish spike injuries grew clinically relevant bacteria resistant to amoxicillin and clavulanic acid, including methicillin-resistant Staphylococcus aureus.
• The study by 5 reports a case of a fish hook in the cervical esophagus, which required prompt retrieval and emphasizes the importance of proper management of foreign body ingestion.

Wound Care and Complications

• Wound care following successful removal of a fish hook involves extraction of foreign bodies from the wound and the application of a simple dressing, as stated in the study by 2.
• The study by 3 found that there were no wound infections or complications in cases where the fish hook was removed during the emergency department encounter.
• However, the study by 4 suggests that clinicians should consider the presence of resistant marine-specific bacteria in cases where there is sepsis or inadequate response to initial therapy.