What is the role of empiric antibiotics in the treatment of infectious flexor tenosynovitis?

Updated: Oct 25, 2017
  • Author: Mark R Foster, MD, PhD, FACS; Chief Editor: Harris Gellman, MD  more...
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Answer

Empiric antibiotics for penetrating trauma include the following:

  • Otherwise healthy individuals - Cefazolin 1-2 g IV every 6-8 hours; if penicillin-allergic, clindamycin 600 mg IV every 8 hours or erythromycin 500-1000 mg IV every 6 hours
  • Immunocompromised individuals - Ampicillin-sulbactam 1.5-3 gm IV every 6 hours, OR cefoxitin 2 g IV every 6-8 hours; if penicillin-allergic, clindamycin 600 mg IV every 8 hours PLUS levofloxacin 500 mg IV once daily (for adults) OR clindamycin plus trimethoprim-sulfamethoxazole (TMP-SMZ) (for children)
  • Bite wound - Same as in immunocompromised individual

For patients who are immunocompromised or have diabetes, early surgical intervention is warranted. If medical treatment alone is attempted, then inpatient observation for at least 48 hours is indicated. Surgical drainage is necessary if no obvious improvement has occurred within 12-24 hours.


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