For an infected dorsal hand laceration being treated on an outpatient basis, which antibiotic regimen is appropriate?

• A. Unasyn 3 grams IV
• B. Cefazolin
• C. Doxycycline
• D. Augmentin 875 mg BID

Answer: (D)

Infected hand wounds, especially on the dorsum, are usually contaminated with skin flora and oral flora, including anaerobes and potential bite-related organisms. The antibiotic chosen for outpatient therapy needs to cover both aerobes and anaerobes and be available orally. Amoxicillin-clavulanate (Augmentin) provides broad coverage of Staphylococcus and Streptococcus species, anaerobes, and beta-lactamase–producing organisms, and it also covers bite-associated organisms like Eikenella. That makes it well suited for a polymicrobial hand infection treated as an outpatient.

Cefazolin covers primarily streptococci and MSSA but lacks anaerobic coverage, which is often important in hand infections. Doxycycline can cover MRSA but does not reliably cover anaerobes or Eikenella, limiting its effectiveness for these wounds. Unasyn is effective but is given intravenously, making it less practical for outpatient management.

Therefore, Augmentin 875 mg twice daily is the best outpatient option for an infected dorsal hand laceration.