Prophylactic antibiotics for subungual hematoma

Report By: Jonathan Costello - SpR Emergency Medicine
Search checked by Marten Howes - SpR Emergency Medicine
Institution: Royal Preston Hospital
Date Submitted: 6th June 2003
Date Completed: 1st July 2004
Last Modified: 1st July 2004
Status: Green (complete)

Three Part Question

In [the management of subungual hematoma], are [prophylactic antibiotics] indicated to [improve outcome]?

Clinical Scenario

A 25 year old labourer presents to the emergency department with a subungual hematoma of acute onset. After trephination, the patient requests antibiotics. You wonder if such prophylaxis is indicated.

Search Strategy

Medline using the OVID interface 1996-03/04.
[Exp antibiotics OR antibiotic$.mp OR exp antibiotic prophylaxi OR antibiotic prophylaxis.mp OR prophylactic antibiotics.mp] AND [exp hematoma OR hematoma.mp OR haematoma.mp OR clot.mp] AND [exp nails OR nail$.mp OR ungual$.mp OR subungual$.mp]

Search Outcome

Two papers were found neither of which were relevant.

Comment(s)

There are no trials of any kind looking at the use of antibiotics on the incidence of infections or complications post subungual trephination.

Clinical Bottom Line

There is no evidence for antibiotic prophylaxis in the management of uncomplicated subungual hematoma.