A short cut review was carried out to establish whether antibiotic prophylaxis is indicated after trephining of a subungual haematoma. Two papers were found using the reported search, of which neither presented any evidence to answer the clinical question. It is concluded that there is no evidence available to answer this question. Further research is needed.
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Report by Jonathan Costello,Specialist Registrar Checked by Marten Howes, Specialist Registrar
A 25 year old labourer presents to the emergency department with a subungual haematoma of acute onset. After trephination, the patient requests antibiotics. You wonder if such prophylaxis is indicated.
Three part question
In [the management of subungual hematoma] are [prophylactic antibiotics] indicated to [improve outcome]?
Medline 1966-03/04 using the OVID interface. (Exp antibiotics OR antibiotic$.mp OR exp antibiotic prophylaxis OR antibiotic prophylaxis.mp OR prophylactic antibiotics.mp) AND (exp hematoma OR hematoma.mp OR haematoma.mp OR clot.mp) AND (exp nails OR exp Nail Diseases OR nail$.mp OR ungual$.mp OR subungual$.mp)
Two papers were found neither of which were relevant.
There are no trials of any kind looking at the use of antibiotics on the incidence of infections or complications after subungual trephination.
CLINICAL BOTTOM LINE
There is no evidence for antibiotic prophylaxis in the management of uncomplicated subungual haematoma.
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