Hospitalization and parenteral antibiotics often are indicated. Wounds should be explored, copiously irrigated, and surgically debrided. Prophylactic oral antibiotics should be used if outpatient therapy is chosen. Parenteral first-generation cephalosporin or antistaphylococcal penicillin and penicillin G or Beta-lactamase inhibitor such as ampicillin-sulbactam or amoxicillin-clavulanate potassium or Second-generation cephalosporin such as cefoxitin (Mefoxin) aureus, streptococci, Eikenella corrodens, gram-negative bacilli, anaerobes Incision and drainage with catheter irrigation of the sheath should be performed if no improvement within the first 12 to 24 hours of conservative therapy. albicans should be suspected in sexually active or immunocompromised patients. Use ceftriaxone (Rocephin) or a fluoroquinolone if Neisseria gonorrhoeae is suspected.
Parenteral first-generation cephalosporin or antistaphylococcal penicillin and penicillin G or Parenteral beta-lactamase inhibitor such as ampicillin-sulbactam (Unasyn) Incision and drainage are contraindicated.
Oral antibiotic therapy usually is adequate.Īntivirals may be prescribed if infection has been present for less than 48 hours.įor recurrent herpetic whitlow, suppressive therapy with an antiviral agent may be helpful.Ĭonsider antibiotics if secondarily infected. If infection is chronic, suspect Candida albicans.Įarly infections without cellulites may respond to conservative therapy.įirst-generation cephalosporin or anti-staphylococcal penicillin Incision and drainage should be performed if infection is well established. Usually Staphylococcus aureus or streptococci pseudomonas, gram-negative bacilli, and anaerobes may be present, especially in patients with exposure to oral floraįirst-generation cephalosporin or anti-staphylococcal penicillin if anaerobes or Escherichia coli are suspected, oral clindamycin (Cleocin) or a beta-lactamase inhibitor such as amoxicillin-clavulanate potassium (Augmentin) Possible sexually transmitted disease exposureįlexor tenosynovitis as well as cutaneous abscesses are known potential sequelae of disseminated N. This organism is quite fastidious and often responsible for chronic, indolent hand infections. The culprit organism is more likely to be Mycobacterium marinum. They require the use of broader spectrum antibiotics. Patients commonly present with subcutaneous abscesses and tendon sheath infections. Mixed aerobic and anaerobic hand infections are common and usually caused by oral pathogens. 1, 3, 5Ĭandidal flexor tenosynovitis infection has been reported in patients who are immunocompromised. Pyogenic flexor tenosynovitis as well as cutaneous abscesses are known potential sequelae of disseminated Neisseria gonorrhoeae and are more common in patients who are immunocompromised. More susceptible to opportunistic infections. Immunocompromised state (patients on immunosuppressive therapy and patients with HIV infection or AIDS) Patients on renal dialysis pose the highest risk. Susceptible to more severe infections and more likely to require surgical intervention. Higher incidence of mixed and pure gram-negative organisms (approaching 30 to 40 percent) requiring use of broader spectrum antibiotics. Wound exploration, copious irrigation, and appropriate antibiotics can prevent undesired outcomes. A clenched-fist injury usually is the result of an altercation and often involves injury to the extensor tendon, joint capsule, and bone. Treatment consists of parenteral antibiotics and sheath irrigation. Pyogenic flexor tenosynovitis is an acute synovial space infection involving a flexor tendon sheath. Pyogenic flexor tenosynovitis and clenched-fist injuries are more serious infections that often require surgical intervention. Early treatment with oral antiviral agents may hasten healing. Herpetic whitlow is a painful infection caused by the herpes simplex virus. Amore advanced felon requires incision and drainage. An early felon may be amenable to elevation, oral antibiotics, and warm water or saline soaks. Afelon is an abscess of the distal pulp of the fingertip. Treatment consists of incision and drainage, warm-water soaks and, sometimes, oral antibiotics. Paronychia, an infection of the epidermis bordering the nail, commonly is precipitated by localized trauma. Tetanus prophylaxis is indicated in patients who have at-risk infections. Many hand infections improve with early splinting, elevation, appropriate antibiotics and, if an abscess is present, incision and drainage. Host factors, location, and circumstances of the infection are important guides to initial treatment strategies. Hand infections can result in significant morbidity if not appropriately diagnosed and treated.
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