TABLE 2.

Antimicrobial Therapy for Wounds Exposed to Aquatic Environments

Prophylaxis 12	First-generation cephalosporin* (eg, cefazolin 1g IV every 8 hours) or clindamycin† 600 mg IV every 8 hours
Basic coverage	Plus fluoroquinolone (eg, levofloxacin 750 mg IV daily)
Estuary/ocean exposure	Add tetracycline (eg., doxycycline 100 mg IV every 12 hours)‡
Contaminated water	Add metronidazole§ 500 mg IV every 6 hours
Targeted Therapy12 Vibrio vulnificus Mycobacterium marinum	3rd generation cephalosporin (eg, ceftriaxone) plus tetracycline (doxycycline, minocycline, tigecycline) or fluoroquinolone (eg, levofloxacin) Follow in-vitro susceptibility testing; many strains are susceptible to rifampin, ethambutol, clarithromycin, and sulfa-containing antibiotics; generally resistant to isoniazid and pyrazinamide; long antibiotic course (mean 14 weeks)

*Can consider 3rd generation cephalosporin (eg, ceftriaxone 1 g every 12 hours) for coverage of gram-negative marine organisms as standard prophylaxis in trauma bay or operating room setting.

†For patients allergic to penicillin or cephalosporins.

‡Standard prophylaxis for Vibrio and other gram-negative aquatic/marine species; administration route dependent on clinical picture: IV for severe wounds, hospitalized patients; PO therapy appropriate for patients to be discharged, or in situations where Vibrio prophylaxis is needed but patient cannot receive ceftriaxone due to allergies or outpatient setting.

§Not needed if patient is already covered with clindamycin.

IV, intra-venous.