Simplified oral antibiotic regimen for pyogenic flexor tenosynovitis

Pyogenic flexor tenosynovitis is a common, potentially serious hand infection. Although initial management is surgical, postoperative antibiotic strategies vary. We evaluated a protocol combining minimally invasive surgical irrigation with a short (7-10 day) course of oral antibiotics, reporting infection control and functional outcomes at six months.

In this prospective observational cohort, consecutive patients treated for pyogenic flexor tenosynovitis between 2 November 2022, and 30 October 2024 were managed as outpatients or with brief hospital stays. The standardized protocol comprised minimally invasive lavage followed by a single oral antibiotic course (median 8 days). Primary endpoints were treatment failure and functional status at six months (Patient-Rated Wrist Evaluation, PRWE). We analysed failure rates, predictors of failure, and determinants of functional outcome.

One hundred and forty-eight patients were included; 93% were treated on an outpatient basis. All received postoperative oral antibiotics, predominantly amoxicillin-clavulanate (96%); median duration was 8 days. Overall failure rate was 6.8%. Stage IIB phlegmon was independently associated with treatment failure (p = 0.033). At six months, 86 patients were reassessed: 74% had PRWE ≤ 10, consistent with minimal or no functional impairment. Higher phlegmon stage (p = 0.032), longer treatment delay (p = 0.013), and occurrence of treatment failure (p = 0.011) were significantly associated with worse functional outcome.

For stage I and IIA pyogenic flexor tenosynovitis, outpatient management combining minimally invasive surgical lavage and a one-week oral antibiotic regimen appears safe and effective. Patients with stage IIB disease have higher failure risk and may require an adapted approach.