title: Antibiotic prophylaxis for ED patients with simple hand lacerations: a feasibility randomized controlled trial.
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).
  
  
  RESULTS
  (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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY. Electronic address: nicole.berwald@gmail.com.
authors.forename: Nicole
authors.initials: N
authors.lastname: Berwald
authors.affiliation: Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, MD.
authors.forename: Feras
authors.initials: F
authors.lastname: Khan
authors.affiliation: Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, NY.
authors.forename: Shahriar
authors.initials: S
authors.lastname: Zehtabchi
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002506:Cephalexin / Q000627:therapeutic use*; D002981:Clindamycin / Q000627:therapeutic use*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006230:Hand Injuries / Q000628:therapy*; D006801:Humans; D022125:Lacerations / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014946:Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D014014:Tissue Adhesives; D002981:Clindamycin; D002506:Cephalexin