Abstract
Background
The benefit of antibiotic prophylaxis for simple hand lacerations (lacerations that
do not involve special structures) has not been adequately studied.
Objective
To assess the feasibility of a randomized controlled trial to determine the role of
antibiotic prophylaxis in emergency department (ED) patients with simple hand lacerations.
Methods
Randomized, double-blind, placebo-controlled pilot trial in 2 urban academic EDs.
Adult (≥18 years old) patients with simple hand lacerations were randomized to cephalexin,
500 mg; clindamycin, 300 mg; or placebo (every 6 hours for 7 days, all in identical
capsules). Outcomes: (1) feasibility determined by the number of patients who agreed
to enroll and number of patients who completed follow-up, (2) infection rate (determined
by 2 physicians at 10-14 days), (3) satisfaction with wound appearance (measured by
a visual analogue scale at 30 days via phone). Medians, quartiles, and percentages
with 95% confidence intervals (CI) were used to present data. Groups were compared
with Kruskal-Wallis and Fisher exact tests, when appropriate.
Results
Over a 5-month period, 123 patients were approached, and 78 consented to enrollment
(63%; 95% CI, 55-71%). Five were lost to follow-up (5/78, 6%; 95% CI, 2%-14%). Only
one patient had infection on follow-up for an infection rate of 1% (95% CI, 0.01%-8%).
Patient’s satisfaction with wound appearance did not differ among the groups.
Conclusion
The findings of this pilot study support the feasibility of a randomized, double-blind,
controlled trial. The low rate of infection suggests the need of a large sample size
for the trial.
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Article Info
Publication History
Published online: April 04, 2014
Accepted:
March 25,
2014
Received in revised form:
March 25,
2014
Received:
January 27,
2014
Footnotes
☆Source of support: None.
☆☆Name of organization and date of assembly if the article has been presented: Poster presentation at the American College of Emergency Physicians, 2012 ACEP Research Forum.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
