Boxing wound

 Q: 28 years old professional boxer is admitted to trauma unit after a clenched fist injury at his face. On examination, there is a concern for possible wound infection. Trauma and plastic surgeons are on board. Patient reports a life-threatening allergy to penicillin. Which of the following antibiotic can be administered as a monotherapy?

A) Ceftriaxone

B) Clindamycin 

C) Levofloxacin

D) Moxifloxacin 

E) Imipenem-cilastatin

Answer: D

In a boxing wound, all the suspected flora of the skin and mouth flora needs to be covered including anaerobes. Ampicillin-sulbactam or Piperacillin-tazobactam is usually enough as a monotherapy. 

In patients with a severe allergy to penicillin, dual-therapy is required including clindamycin or metronidazole with regularly used fluoroquinolones such as Ciprofloxacin or Levofloxacin. The only fluoroquinolone which can be used as monotherapy is Moxifloxacin. Moxifloxacin has pretty good anaerobic activity. 

It would be prudent to avoid cephalosporin or a carbapenem in this patient with a life-threatening penicillin allergy.

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Reference:

Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:147.