cefamandole and Hand-Injuries

Eighty-seven patients participated in a prospective, double-blind, clinical study to determine the efficacy of preventive antibiotics in the management of common open traumatic hand wounds ranging in severity from single nail bed injuries with open fractures to moderately contaminated wounds involving tendon, bone, joint, and neurovascular structures. Under current medical practice, these wounds would be treated with antibiotics. Thirty-nine patients received intravenous cefamandole and oral cephalexin and 48 received intravenously and orally administered placebo. With an overall infection rate of 1.1%, there were no infections in the antibiotics group and only one (2.1%) infection in the placebo group. Aerobic cultures from 97 similar wounds were 53.6% positive predebridement and 50.5% positive postdebridement. There was no significant difference in rates of infection or imperfect wound healing between the two groups. The preventive antibiotics administered were not necessary in treating these wounds when accompanied by debridement, irrigation, and rapid primary repair in an operating room environment.

Topics: Adolescent; Adult; Ambulatory Care; Cefamandole; Cephalexin; Child; Child, Preschool; Debridement; Double-Blind Method; Hand Injuries; Humans; Infant; Infant, Newborn; Intraoperative Period; Postoperative Period; Prospective Studies; Random Allocation; Surgical Wound Infection; Therapeutic Irrigation

In a prospective, double-blind study, 193 patients hospitalized for established hand infections were randomized to receive either cefamandole intravenously followed by cephalexin by mouth or methicillin intravenously followed by dicloxacillin by mouth. Careful aerobic and anaerobic cultures were performed. Multiple organisms grew in cultures from 84% of the patients (over three isolates per infection on average). Human bite wounds contained anaerobes 43% of the time compared with 12% for other wounds. The majority of wounds (72%) required operative treatment. In 128 patients assessable for treatment outcome, results were unsatisfactory in 11 (9%). There was no difference in outcome between cefamandole (6/59, 10%) and methicillin (5/59, 8%). The presence of anaerobes, Eikenella corrodens, human bites, or an increasing number of organisms was associated with an unsatisfactory response. The presence of Staphylococcus aureus and/or beta-hemolytic streptococci was associated with a favorable response. The incidence of antibiotic-resistant isolates did not correlate with outcome.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bites and Stings; Bites, Human; Cefamandole; Clinical Trials as Topic; Combined Modality Therapy; Debridement; Double-Blind Method; Follow-Up Studies; Hand Injuries; Humans; Methicillin; Middle Aged; Prospective Studies; Random Allocation; Time Factors

Topics: Cefamandole; Cefoxitin; Hand Injuries; Humans