Orthopedic Surgery for Hand Infections Medication

Updated: Oct 22, 2019
  • Author: Matthew B Klein, MD; Chief Editor: Harris Gellman, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, reduce morbidity, and prevent complications.

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Antibiotics

Cephalexin (Keflex, Daxbia)

This antibiotic is a first-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell-wall synthesis. It has bactericidal activity against rapidly growing organisms. Its primary activity is against skin flora; it is used for skin infections or prophylaxis in minor procedures.

Cefazolin

A first-generation semisynthetic cephalosporin that arrests bacterial cell-wall synthesis, inhibiting bacterial growth. It is primarily active against skin flora, including Staphylococcus aureus, and is typically used alone for skin and skin-structure coverage. Intravenous (IV) and intramuscular (IM) dosing regimens are similar.

Clindamycin (Cleocin)

Clindamycin is active against anaerobic gram-negative bacilli. It is a lincosamide that is useful in treating serious skin and soft tissue infections caused by most staphylococcal strains. It is also effective against aerobic and anaerobic streptococci, except enterococci. Clindamycin inhibits bacterial protein synthesis by inhibiting peptide chain initiation at the bacterial ribosome, which is where it preferentially binds to the 50S ribosomal subunit, causing bacterial growth inhibition. Cultures should be performed to test for possible resistance.

Levofloxacin (Levaquin)

Levofloxacin is indicated for pseudomonal infections and for infections that are due to multidrug-resistant, gram-negative organisms. Cultures should be performed to test for possible resistance.

Trimethoprim/sulfamethoxazole (Bactrim, Bactrim DS)

Inhibits bacterial synthesis of dihydrofolic acid by competing with para-aminobenzoic acid. This results in the inhibition of bacterial growth.

Tetracycline

Tetracycline inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunits. Primarily bacteriostatic, it has anti-inflammatory activity and is active against a wide range of gram-positive and gram-negative organisms.

Gentamicin

This aminoglycoside that may be used as an alternative to streptomycin, although there has been less clinical experience with gentamicin than with streptomycin in the treatment of tularemia. The drug may be administered intravenously or intramuscularly. Many dosing schedules are based on creatinine clearance (CrCl), volume of distribution, site of infection, and type of infection. Monitor serum levels after steady state is reached (usually after 3-4 doses). Trough levels are usually obtained 0.5 hour before the dose; peak levels are usually obtained 1 hour after the dose is infused.

Moxifloxacin (Avelox)

Moxifloxacin inhibits the A subunits of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription.

Vancomycin

Vancomycin is indicated for patients who have infections with resistant staphylococci. To avoid toxicity, the current recommendation is to assay vancomycin trough levels after the third dose is drawn 0.5 hour prior to next dosing. Use CrCl to adjust the dose in patients diagnosed with renal impairment.

Daptomycin (Cubicin)

Causes membrane depolarization by binding to components of the cell membrane of susceptible organisms. Inhibits DNA, RNA, and protein synthesis intracellularly. It is a bactericidal antibiotic.

Linezolid (Zyvox)

Linezolid is used as an alternative drug in patients allergic to vancomycin and for treatment of vancomycin-resistant enterococci. It is also effective against MRSA and penicillin-susceptible S pneumoniae infections.

This agent is an oxazolidinone antibiotic that prevents formation of the functional 70S initiation complex, which is essential for bacterial translation process. Linezolid is bacteriostatic against enterococci and staphylococci and bactericidal against most strains of streptococci.

Rifampin (Rifadin)

Rifampin is for use in combination with at least 1 other anti-tuberculosis drug. It inhibits RNA synthesis in bacteria by binding to the beta subunit of DNA-dependent RNA polymerase, which in turn blocks RNA transcription. Cross-resistance may occur.

Penicillin VK

Penicillin VK is the drug of choice for patients who can tolerate oral therapy. It inhibits the biosynthesis of cell wall mucopeptide. It is bactericidal against sensitive organisms when adequate concentrations are reached and is most effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

Ampicillin/sulbactam (Unasyn)

Drug combination of beta-lactamase inhibitor with ampicillin. Interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. Alternative to amoxicillin when unable to take medication PO.Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.

Amoxicillin/clavulanate (Augmentin, Augmentin ES-600, Augmentin XR)

Amoxicillin inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Addition of clavulanate inhibits beta-lactamase–producing bacteria.Good alternative antibiotic for patients allergic to or intolerant to macrolides. Usually is well tolerated and provides good coverage for most infectious agents. Not effective against Mycoplasma and Legionella species. Half-life of oral dosage form is 1-1.3 h. Has good tissue penetration but does not enter cerebrospinal fluid.

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Antifungals, Other

Class Summary

Antifungal therapy should be started immediately after necessary cultures have been obtained from all suspected sites of infection. Azole antifungal agents are fungicidal at very high concentrations. Azoles function by selectively inhibiting the synthesis of an essential component of fungal cell membrane, ergosterol.

 

Miconazole oral (Oravig)

Inhibits biosynthesis of ergosterol, damaging fungal cell wall membrane, which results in fungal cell death.

Clotrimazole

Nonabsorbable imidazole. Broad-spectrum synthetic antifungal agent that inhibits growth of yeasts and fungal growth by altering cell membrane permeability, which causes fungal cell death.

Itraconazole (Onmel, Sporanox)

Has fungistatic activity. Synthetic triazole antifungal agent that slows fungal cell growth by inhibiting cytochrome P-450–dependent synthesis of ergosterol, a vital component of fungal cell membranes. Effective against broad range of fungi, including Candida species and is indicated for the treatment of cutaneous, oral, esophageal, and disseminated candidiasis. Available in IV, 100-mg capsules, and oral solution at 10 mg/mL.Capsules require gastric acidity for absorption and should be taken with food to increase absorption. Liquid formulation increases bioavailability and decreases need for acidity for proper absorption.

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