From the Research
For a pediatric patient with a large hand laceration, I recommend amoxicillin-clavulanate (Augmentin) as the first-line antibiotic choice, as it is effective against the most common bacteria implicated in hand infections, including Staphylococcus aureus and Streptococcus species, as suggested by 1. The typical dosing is 25-45 mg/kg/day divided into two doses for 5-7 days. For children weighing less than 40 kg, the suspension formulation (400/57 mg per 5 mL) is appropriate, while older children can take tablets. Before starting antibiotics, the wound should be thoroughly cleaned, irrigated, and properly closed if needed. Prophylactic antibiotics are indicated for large lacerations, especially on the hand, due to the high risk of infection from both skin flora and environmental contaminants. Hand wounds are particularly concerning because infections can spread to tendons and deeper structures. Some key points to consider when treating hand infections include:
- Identifying the cause of the infection and initiating prompt and appropriate medical or surgical treatment can prevent substantial morbidity, as noted in 2.
- The most common bacteria implicated in hand infections remain Staphylococcus aureus and Streptococcus species, as stated in 2.
- Methicillin-resistant S aureus infections have become prevalent and represent a difficult problem best treated with empiric antibiotic therapy until the organism can be confirmed, as mentioned in 2. Alternative options include cephalexin (25-50 mg/kg/day divided into four doses) for patients with non-severe penicillin allergy, or clindamycin (30-40 mg/kg/day divided into three doses) for those with severe penicillin allergy, as suggested by 1. Tetanus prophylaxis should also be administered if the child's immunization status is incomplete or unknown. The patient should be monitored for signs of infection including increasing pain, redness, swelling, warmth, or drainage from the wound. It is also important to note that amoxicillin-clavulanate has been shown to be effective in treating mixed bacterial skin infections involving beta-lactamase-producing organisms, as demonstrated in 3. Additionally, the use of topical antibiotics may be considered as potential primary therapy in some cases, as mentioned in 4. However, the use of amoxicillin-clavulanate as the first-line antibiotic choice is supported by the most recent and highest quality evidence, as stated in 1.