Traumatic Wounds/Lacerations

Antimicrobial prescribing: NHS Borders
NHS Borders

Traumatic Wounds/Lacerations

Wound infection occurs in 1 – 12% of all non-bite wounds. 

Antibiotic prophylaxis or tetanus immunoglobulin is not usually required for simple, clean lacerations.

Wound cleaning with irrigation from tap water or normal saline is the main stay of infection prevention.  

Local anaesthetic use is essential for deeper/larger wounds to explore and clean appropriately (topical Lidocaine, Adrenaline & Tetracaine LAT gel if needle phobic/paediatric according to ED procedure). If there is concern that the wound is not possible to washout in ED then consideration of washout in theatre is an option.

For highly contaminated wounds antibiotic cover may be considered as an adjunct to washout.  

Do not close wounds that remain contaminated.

Safety net advice for all wounds: seek healthcare professional advice (GP/pharmacy/ED) if there is heat or redness spreading from the wound (usually in the first 2-4 days), or if the patient feels feverish/unwell.

Human tetanus immunoglobulin should be given to all high-risk tetanus prone wounds (heavily contaminated with soil / faeces or devitalised tissue), irrespective of the tetanus immunisation history.

Tetanus vaccine should be given if necessary, according to immunisation history.

Ref:  Green Book, Tetanus (chapter 30)

https://www.gov.uk/government/publications/tetanus-the-green-book-chapter-30

Recommended Antimicrobials

Duration

5 days is usual

Treatment of clean lacerations that become infected

Consider antimicrobial prophylaxis if patient is immunocompromised e.g. diabetic, asplenic, alcohol dependant or laceration is stellate, intra-oral or to the feet.  Antibiotics are as for treatment.

Flucloxacillin 1g oral 6 hourly

Penicillin allergy

Doxycycline 100mg 12 hourly

Treatment of infected lacerations that were previously contaminated; puncture wounds or wounds with a significant amount of devitalised tissue

Consider antimicrobial prophylaxis in puncture wounds or wounds contaminated with soil, manure or faeces and wounds with a significant amount of devitalised tissue.  Antibiotics are as for treatment.

Co-amoxiclav (Amoxicillin / Clavulanic acid) 625mg oral 8 hourly

Penicillin allergy

Doxycycline 100mg 12 hourly

+

Metronidazole oral 400mg 8 hourly

Editorial Information

Last reviewed: 14/09/2025

Next review date: 30/09/2028

Author(s): Duguid, A.

Version: 3.0

Co-Author(s): James, E, Taylor, J, McCarthy, C, Dauncey, S, Longworth, E.

Approved By: NHS Borders Antimicrobial Management Team

Reviewer name(s): Duguid, A.