Management

Initial treatment of hand infection is dependent on several factors:

• presentation greater than 48 hours after onset of symptoms
• immunocompromise
• throbbing pain at night
• localized tenderness for more than 2 days
• pain for more than 2 days
• induration The presence of one or more of these factors encourages the clinician to opt for surgical intervention in addition to antibacterial treatment.

If there is pus near the surface, this should be cultured before commencing therapy. Minor infections can be treated with broad spectrum antibiotics e.g. co-amoxiclav. More extensive or severe infections like cellulitis may respond to intravenous antibiotics e.g. flucloxacillin and metronidazole. Antibiotics are modified in the light of bacterial sensitivity.

Follow-up is essential. Ideally, the patient should be seen within 24 hours of treatment.