PENICILLIN PROPHYLAXIS IN COMPLICATED WOUNDS OF HANDS AND FEET - A RANDOMIZED, DOUBLE-BLIND TRIAL

The purpose of the study was to examine the effect of prophylactic pen icillin treatment on the infection rate in patients with traumatic wou nds of hands or feet with underlying lesions of bone, tendon or joint. A total of 599 patients were randomized to doable-blind treatment wit h either (A) one injection of penicillin G, (B) penicillin V tablets f or 6 days or (C) no antibiotic treatment. In group A the infection rat e was 4.9 per cent, in group B 6.7 per cent and in group C 10.2 per ce nt. The difference between the infection rates in group A and C was 5. 3 per cent with a 95 per cent confidence interval (CI) from 0.1 to 10. 4 per cent (P = 0.046). Correction for an interim analysis and subgrou p analyses increases this P value to 0.096. The difference between the infection rates in group B and C was 3.6 per cent (95 per cent CI fro m -1.9 to 8.9, P = 0.20). Patients in group B had gastrointestinal com plaints Foe times as often as patients in group A and C. Prophylactic tablets for 6 days require patients' co-operation while an injection e nsures that the prophylaxis is given. We therefore conclude that a sin gle prophylactic injection of two million units of penicillin G is adv isable for patients with these injuries. (C) 1996 Elsevier Science Ltd .