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A 25-year-old man is evaluated because of pain and swelling of his right hand. Three days ago, he was involved in an altercation during which he punched another man in the mouth with his right fist.
On physical examination, temperature is 38.3 °C (101 °F). Examination of the right hand discloses pain and swelling over the second metacarpophalangeal joint and evidence of decreased range of motion. Aspiration of the joint reveals a small amount of purulent material; samples are submitted for culture.
While awaiting culture results, which of the following is most appropriate?
A Ampicillin“sulbactam
B Cefazolin
] C Trimethoprim“sulfamethoxazole
] D Metronidazole plus ciprofloxacin
E Observation only until culture results are available
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sir answer plz.
we always studies amoxcillin plus clavulanic acid.
but now here options r diff.
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For human bites, agents with activity against S. aureus, H. influenzae, and -lactamase-positive oral anaerobes should be used. The combination of an extended-spectrum penicillin with a -lactamase inhibitor (amoxicillin/clavulanic acid, ticarcillin/clavulanic acid, ampicillin/sulbactam) appears to offer the most reliable coverage for these pathogens. Second-generation cephalosporins (cefuroxime, cefoxitin) also offer substantial coverage.
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Correct Answer = A)
Key Point
Empiric antibiotic therapy while awaiting culture results is required for patients with an infected clenched-fist injury.
This patient has a clenched-fist injury of his right hand that has likely been infected with the oropharyngeal flora of his victim. Empiric therapy is required before culture results are available. Organisms to consider in this patient are aerobic and anaerobic streptococci, other anaerobes (including β-lactamase“producing strains), staphylococci, and Eikenella corrodens, all of which can be treated with ampicillin“sulbactam.
Cefazolin is not effective against anaerobes or E. corrodens, and trimethoprim“sulfamethoxazole does not cover all streptococci. The combination of metronidazole plus ciprofloxacin is not adequate against streptococci or staphylococci. Patients with infected clenched-fist injuries should be hospitalized for intravenous antibiotics and possible surgical debridement because of the close proximity of the skin overlying the knuckles to the joint capsule and the potential spread of infection into subcutaneous, subfascial, subtendinous, subaponeurotic, and web spaces.
