Know what to do for puncture wounds and the appropriate antibiotic therapy for pediatric patients
Know what to do for puncture wounds and the appropriate antibiotic therapy for pediatric patients: Excerpt from Avoiding Common Pediatric Errors
Author:
Laura Hufford, MD
What to Do - Make a Decision
Puncture wounds are a common form of minor trauma in the pediatric population. Although they are painful, these wounds usually heal easily and do
not require medical attention. Complications of puncture wounds include
retained foreign bodies and secondary infections. The most common organisms to cause secondary infections are Staphylococcus and Streptococcus
species.Additionally,plantarpuncturewoundsareatriskforanaerobicinfections, including those organisms likely seeded from the soil, a foreign body,
or shoe. Pseudomonas aeruginosa infection can cause invasive, debilitating
disease, such as osteochondritis and osteomyelitis.
Physical examination should be performed, looking for changes in sensation or motor function, erythema, swelling, and increased warmth, which
suggestsinjuryorinfection.Initialmanagementincludesirrigationandclose
inspection for a retained foreign body. If there is high degree of suspicion for
a foreign body and it cannot be easily visualized, radiographic studies and
possible surgical exploration may be indicated.
Patients presenting within a day of the puncture rarely demonstrate
signs of infection and thus management should be limited to rest and frequent foot soaks. However, patients presenting >24 hours often have pain,
erythema, and swelling. Once the possibility of a retained foreign body has
been eliminated, the clinician should consider whether the patient should
receive oral antistaphylococcal antibiotics. Typically, if the puncture wound
is shallow, no antibiotic prophylaxis is recommended; however, if the wound
is "dirty" or deep, as are those more typically occurring in the foot, antibiotic
prophylaxis isrecommended.Thesepatientsshouldreturnforre-evaluation
within 48 hours. If symptoms persist, hospital admission should occur for
parenteral antibiotic therapy including coverage for P. aeruginosa.
Of note, oral fluoroquinolones are not indicated for prophylaxis of plantarpuncturewounds.Duringthedevelopmentoffluoroquinolones,thedrugs
were found to causeirreversible arthropathy ingrowing animals. Thus, there
are few U.S. Food and Drug Administration-licensed pediatric indications
for these medications. The American Academy of Pediatrics Committee
on Infectious Diseases, 2004–2005 stated that parenteral treatment of osteomyelitis or osteochondritis caused by P. aeruginosa is an appropriate use
of fluoroquinolone medications.
Suggested Readings
Baldwin G, Colbourne M. Puncture wounds. Pediatr Rev. 1999;20(1):21–23.
Chachad S, Kamat D. Management of plantar puncture wounds in children. Clin Pediatr. 2004;
43:213–216.
Committee on Infectious Disease. The use of systemic fluoroquinolones. Pediatrics. 2006;118:
1287–1292.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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