Question of the Week # 472

A 9-year-old boy is brought to the hospital with a wound to his left hand. He was in a fight with peer who bit him. His past medical history is unremarkable and he takes no medications. He has no known allergies. On examination, the child is crying. There is a 2-cm wound over the dorsum of his palm. What is the most appropriate course of action?
A. Clean the wound and prescribe amoxicillin-clavulanate.
B. Clean the wound and prescribe doxycycline.
C. Clean the wound and prescribe ciprofloxacin.
D. Clean the wound, close it with interrupted sutures and prescribe ciprofloxacin.
E. Clean the wound, close it with interrupted sutures and prescribe amoxicillin-clavulanate.

5 Responses

  1. B is answer

  2. E is the answer

  3. A

  4. A

  5. A. Two things to consider here: 1) to close, or not to close ? – generally do not close. 2) Antibiotic – Eikenella corrodens would need more than just amoxicillin since it has betalactamase activity. Another tiny thingy would be the 8 year old treshold, after which one could use doxycycline. Here, though it would be enough to give Sulbactam.

    There’s a third thing that might be asked in this scenario: Tetanus prophylaxis – tetanus immune globulin and the 3-dose vaccine series should be administered to patients with an unknown tetanus vaccine history or those who have received fewer than 3 doses. It is also indicated for patients who received the complete tetanus series, but whose booster administration was more than 5 years ago. For patients with a history of 3 or more doses of tetanus and diphtheria vaccine who received a booster less than 5 years ago, no tetanus booster is required.

    A fourth issue might be a positive HIV status of the one who bit the hand: starting the postexposure HAART might be needed depending how big the wound is, how much of a risk would be the contact between blood of both people.

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