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Pediatric Fingertip Injuries: Do Prophylactic Antibiotics Alter Infection Rates?

Altergott, Caroline MD; Garcia, Francisco J. MD; Nager, Alan L. MD

doi: 10.1097/PEC.0b013e3181666f5d
Original Articles

Study objective: Fingertip injuries are common in the pediatric population. Considerable controversy exists as to whether prophylactic antibiotics are necessary after repair of these injuries. Our goal was to compare the rate of bacterial infections among subgroups treated with and without prophylactic antibiotics. The study hypothesis was that infection rates were similar in the 2 groups.

Methods: This was a prospective randomized control trial of pediatric patients presenting to an urban children's hospital with trauma to the distal fingertip, requiring repair. Patients were randomized to 2 groups: group 1 received no antibiotics, and group 2 received antibiotics (cephalexin). Repairs were performed in a standardized fashion, and all patients were reevaluated in the same emergency department in 48 hours and again by phone 7 days after repair. The primary outcome measure was the rate of infection at 7 days after repair.

Results: One hundred forty-six patients were initially enrolled in the study, 11 patients were withdrawn before study completion, 69 subjects were randomized to the no-antibiotic group, and 66 subjects were randomized to the antibiotic group. There was 1 infection in each group at 7 days after repair. The infection rate was 1.45% (95% confidence interval, 0.04%-7.81%) for the no-antibiotic group and was 1.52% (95% confidence interval, 0.04%-8.16%) for the antibiotic group, not statistically significant (P = 1.00).

Conclusions: This study suggests that routine prophylactic antibiotics do not reduce the rate of infection after repair of distal fingertip injuries.

Department of Pediatrics, Division of Emergency Medicine, Childrens Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA; and Department of Emergency Medicine,Kapiolani Medical Center for Women and Children Hospital, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI.

This study was supported in part by the National Institutes of Health, National Center for Research Resources, and General Clinical Research Center Grant MO1 RR00046 and was performed at the General Clinical Research Center at Childrens Hospital Los Angeles. Computational assistance was provided by the National Institutes of Health, National Center for Research Resources, and General Clinical Research Center Grant MO1 RR00046 and was performed at the General Clinical Research Center at Childrens Hospital Los Angeles.

Address correspondence and reprint requests to Caroline Altergott, MD, Division of Emergency Medicine, Childrens Hospital Los Angeles, Mailstop 113, 4650 Sunset Blvd, Los Angeles, CA 90027. E-mail: caltergott@chla.usc.edu.

© 2008 Lippincott Williams & Wilkins, Inc.