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Antibiotic prophylaxis choice for plantar puncture wounds

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I think most of the literature says cipro alone, which is what I tend to do. However, if its an especially nasty wound or if Im worried about noncompliance Ill go ahead and throw on some keflex to get better staph coverage. Of course in kids I just do the keflex. 

I can understand the argument for doing both to get pseudomonas and staph coverage but I think its probably a bit overkill for most. I always try to remind myself that no drug is benign especially antibiotics and every added drug puts the patient at risk for complications. 

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35 minutes ago, medic25 said:

Working in a beach town, a big chunk of my plantar wounds are saltwater contaminated (lots of people walking barefoot and stepping on clam and oyster shells).  We end us using a lot of doxycycline for Vibrio coverage.

Yup, I do that too. ditto fish hooks in the hand, etc

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3 hours ago, GreatChecko said:

How long to you send for the doxy coverage. I haven't found anything beyond treatment length for vibrio. I've been doing 5 days for an uncomplicated saltwater wound.

That sounds about right.  I've searched high and low for literature or guidelines on this and have never found a published guideline.

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  • 2 weeks later...

Closest thing to a published guideline I have found through IDSA and Hopkins (as well as UTD) is 3-5 days of antibiotic of choice at clinician discretion.  Personally, I use Cipro, as it covers Vibrio species as well as Pseudomonas and MSSA.  Most of the time, I just core the wound, clean aggressively and if I think warranted, Cipro for 3 days with instructions to return if worsening in any way. 


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