ED management includes copious irrigation, wound exploration, and debridement of devitalized tissue. These wounds should never be closed and are allowed to heal by secondary intention. Tetanus is indicated if not up-to-date. Antibiotics should be initiated immediately. If the patient is reliable, and has no signs of infection upon presentation, outpatient oral antibiotics can be used with close follow-up 24 hrs later.
Infection, bone injury, or tendon involvement require admission and IV antibiotics. Appropriate antibiotics include ampicillin/sulbactam, piperacillin/tazobactam, ceftriaxone with metronidazole, or ciprofloxacin with metronidazole or clindamycin. Clindamycin does not cover Eikenella so it should not be used as a sole agent. The joint should be splinted.