366
Injury
From J. R. Bee&y, G. Bowden, R. H. Hardy crnd T. D. R. Reynolds Sir, Minor hand injuries constitute one of the commonest conditions treated in Accident Departments (1400 cases out of 17,000 primary attendances here in the 12-month period 1 August, 1971-31 July, 1972) and yet there is often uncertainty as to whether prophylactic antibiotics are needed or not. We therefore made a double-blind clinical trial in this department to clarify the situation. All patients over the age of 5 with minor hand lacerations, were eligible for the trial with the exception of those whose injuries involved tendon, bone, joint or were obviously contaminated. The standard protocol for treatment was thorough cleansing with cetrimide, debridement of the wound if necessary and suture with 3/O or S/O Dexon or steristrip as appropriate. Sealing of the wound with opsite spray and rest for 5 days were insisted on. All patients were given tetanus toxoid unless already covered. Each patient was asked to report back 5 days after injury when the wound was inspected. If there was infection a swab was taken and appropriate treatment given. Two batches of identical white capsules were supplied by Beecham Pharmaceuticals, one containing 500 mg of Magnapen (flucloxacillin and ampicillin) and the other a placebo. The dosage was I capsule 4 times daily on an empty stomach for 5 days. The patient was allotted to ‘ A ’ or ‘ B ’ therapy according to his accident registration number; even numbers receiving
: the
British
Journal
of Accident
Surgery
Vol. G/No. 4
capsule ’ A ’ and odd numbers capsule ‘ B ‘. Results are summarized briefly as follows: ‘A’ ‘B’ Healed 63 65 I Infected I 6 Rejected 9 Total 70 75 Those patients ’ rejected ’ from the trial had either stopped taking capsules before the course was finished (only 2 because of side effects of diarrhoea) or failed to report for follow-up. The results shows a very low incidence of infection and there is no difference between the two groups. At the end of the trial Capsule ‘ A ’ was identified as containing Magnapen. Within its limitations this trial suggests that antibiotics are unnecessary in these minor hand injuries and that the essence of their care is meticulous wound toilet, careful repair, uniform dressing and after-care. We are particularly grateful to the nursing staff who inevitably provided most of the care of these injuries after diagnosis and to Beecham’s for providing the double blind medication. Yours faithfully, J. R. Beesley G. Bowden II. H. Hardy T. D. R. Reynolds Hereford General Hospital, Nelson Street, Hereford.
Injury
From J. R. Bee&y, G. Bowden, R. H. Hardy crnd T. D. R. Reynolds Sir, Minor hand injuries constitute one of the commonest conditions treated in Accident Departments (1400 cases out of 17,000 primary attendances here in the 12-month period 1 August, 1971-31 July, 1972) and yet there is often uncertainty as to whether prophylactic antibiotics are needed or not. We therefore made a double-blind clinical trial in this department to clarify the situation. All patients over the age of 5 with minor hand lacerations, were eligible for the trial with the exception of those whose injuries involved tendon, bone, joint or were obviously contaminated. The standard protocol for treatment was thorough cleansing with cetrimide, debridement of the wound if necessary and suture with 3/O or S/O Dexon or steristrip as appropriate. Sealing of the wound with opsite spray and rest for 5 days were insisted on. All patients were given tetanus toxoid unless already covered. Each patient was asked to report back 5 days after injury when the wound was inspected. If there was infection a swab was taken and appropriate treatment given. Two batches of identical white capsules were supplied by Beecham Pharmaceuticals, one containing 500 mg of Magnapen (flucloxacillin and ampicillin) and the other a placebo. The dosage was I capsule 4 times daily on an empty stomach for 5 days. The patient was allotted to ‘ A ’ or ‘ B ’ therapy according to his accident registration number; even numbers receiving
: the
British
Journal
of Accident
Surgery
Vol. G/No. 4
capsule ’ A ’ and odd numbers capsule ‘ B ‘. Results are summarized briefly as follows: ‘A’ ‘B’ Healed 63 65 I Infected I 6 Rejected 9 Total 70 75 Those patients ’ rejected ’ from the trial had either stopped taking capsules before the course was finished (only 2 because of side effects of diarrhoea) or failed to report for follow-up. The results shows a very low incidence of infection and there is no difference between the two groups. At the end of the trial Capsule ‘ A ’ was identified as containing Magnapen. Within its limitations this trial suggests that antibiotics are unnecessary in these minor hand injuries and that the essence of their care is meticulous wound toilet, careful repair, uniform dressing and after-care. We are particularly grateful to the nursing staff who inevitably provided most of the care of these injuries after diagnosis and to Beecham’s for providing the double blind medication. Yours faithfully, J. R. Beesley G. Bowden II. H. Hardy T. D. R. Reynolds Hereford General Hospital, Nelson Street, Hereford.
