10.5 Skin and soft tissue injuries
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Clean incised wounds/stroke cuts/sharp cuts involving only skin | Clean the wound and depending on the depth of wound, decision to suture or not to be made. No role of antibiotics | Booster dose of tetanus toxoid to be administered, if the last dose was taken more than 10 years back. | |
| Contused lacerated wounds/Contaminated wounds (farmyard wounds roadside wounds) *Contamination from anaerobic organisms is a possibility | Amoxicillin- clavulanate 625mg q8h for 3 to 7 days based on clinical response | Oral Cefuroxime 500mg BD /oral Clindamycin 300mg q8h In case of features of sepsis: Inj Amoxicillin- clavulanic acid 1.2g q8h for 3 to 7 days based on clinical response | These wounds need to be washed thoroughly with sterile normal saline and need surgical debridement depending on the degree of contusion/contamination. In case of a contaminated/dirty wound, give a booster dose of tetanus toxoid, if last dose was taken more than 5 years back. No need for additional metronidazole. |
For common etiological agents of Skin and soft tissue injuries, see Annexure B.10.5
References
1. Maillard JY, Kampf G, Cooper R. Antimicrobial stewardship of antiseptics that are pertinent to wounds: the need for a united approach. JAC Antimicrob Resist. 2021 Mar 25;3(1):dlab027. doi: 10.1093/jacamr/dlab027. PMID: 34223101; PMCID: PMC8209993
2. Surgical site infections: prevention and treatment. London: National Institute for Health and Care Excellence (NICE); 2020 Aug 19. (NICE Guideline, No. 125.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK542473/
3. Pinchera B, Buonomo AR, Schiano Moriello N, Scotto R, Villari R, Gentile I. Update on the Management of Surgical Site Infections. Antibiotics (Basel). 2022 Nov 11;11(11):1608. doi: 10.3390/antibiotics11111608. PMID: 36421250; PMCID: PMC9686970