[Penicillin prophylaxis in complicated wounds of hands and feet. A randomized, double-blind study]

Five hundred and ninety-nine patients with traumatic wounds of hands or feet with underlying lesions of the bone, tendon or joint, were randomized to double blind treatment with either A) one injection of penicillin, B) penicillin tablets for six days or C) no antibiotic treatment. In group A the infection rate was 4.9%, in group B it was 6.6% and in group C 10.2%. The difference between the infection rates in group A and C was 5.3% with a 95% confidence interval (CI) from 0.1 to 10.4%, (p = 0.046). Correction for an interim analysis and subgroup analysis increases this p-value to 0.096. The difference between the infection rates in group B and C was 3.6% (95%, CI from -1.9 to 8.9%, p = 0.20). Patients in group B had gastrointestinal complaints five times as often as patients in group A and C. Based on the results we advise that a single prophylactic injection of penicillin is given to patients with these injuries.