A school-age child steps on a nail while wearing sneakers and develops cellulitis of the foot; immunizations are up-to-date. What empiric antibiotic is preferred?

A school-age child steps on a nail while wearing sneakers and develops cellulitis of the foot; immunizations are up-to-date. What empiric antibiotic is preferred?

• A. Amoxicillin-clavulanate
• B. Clindamycin
• C. Trimethoprim-sulfamethoxazole
• D. Ciprofloxacin

Answer: (D)

The main idea is that puncture wounds through sneakers carry a high risk of Pseudomonas infection, so the initial antibiotic should cover Pseudomonas even before culture results. Ciprofloxacin provides effective antipseudomonal coverage in children and is suitable for outpatient management of a puncture wound cellulitis. Amoxicillin-clavulanate, clindamycin, and trimethoprim-sulfamethoxazole don’t reliably cover Pseudomonas, which makes them less appropriate in this scenario. In this situation, choosing ciprofloxacin targets the likely pathogen and addresses the infection promptly.

The main idea is that puncture wounds through sneakers carry a high risk of Pseudomonas infection, so the initial antibiotic should cover Pseudomonas even before culture results. Ciprofloxacin provides effective antipseudomonal coverage in children and is suitable for outpatient management of a puncture wound cellulitis. Amoxicillin-clavulanate, clindamycin, and trimethoprim-sulfamethoxazole don’t reliably cover Pseudomonas, which makes them less appropriate in this scenario. In this situation, choosing ciprofloxacin targets the likely pathogen and addresses the infection promptly.