›Hot water immersion
›45 degrees Celsius for 20 minutes
›Denatures heat-labile venom proteins
›Effective analgesic for fire coral stings
›Anti-inflammatory therapy for contact dermatitis
›Topical corticosteroids
›Medium-potency topical steroid for localized reaction
›Triamcinolone 0.1% cream twice daily
›Oral antihistamines for urticaria or pruritus
›Cetirizine 10 mg daily or diphenhydramine 25 to 50 mg every 6 hours
›Second-generation preferred to avoid sedation
›Prophylactic antibiotics
›Minor wounds in immunocompetent hosts
›Prophylactic antibiotics generally NOT required
›Level B evidence from expert consensus and guidelines
›Immunocompromised or liver disease patients
›Oral ciprofloxacin 500 mg twice daily for 3 to 5 days
›TMP-SMX DS twice daily as alternative
›Empiric treatment for established infection
›Mild to moderate infection, oral therapy
›Doxycycline 100 mg PO twice daily
›Active against Vibrio spp. and many marine gram-negatives
›Duration 5 to 7 days for mild infection
›Ciprofloxacin 500 mg PO twice daily
›Alternative to doxycycline for marine wound infections
›Avoid in children and pregnancy
›TMP-SMX DS (160/800 mg) PO twice daily
›Alternative fluoroquinolone-sparing option
›Moderate to severe infection, combination parenteral therapy
›Doxycycline 100 mg IV every 12 hours plus ceftazidime 2 g IV every 8 hours
›Preferred combination for marine wound infections per Auerbach
›Covers Vibrio spp. and gram-negative marine organisms
›Levofloxacin 750 mg IV daily as monotherapy alternative
›Acceptable fluoroquinolone monotherapy for moderate infection
›Piperacillin-tazobactam 4.5 g IV every 6 hours for severe or polymicrobial infection
›Fulminant infection or necrotizing fasciitis
›Imipenem-cilastatin 500 mg IV every 6 hours
›Broad-spectrum coverage for polymicrobial necrotizing infection
›Add vancomycin 15 to 20 mg/kg IV every 8 to 12 hours
›MRSA coverage for skin source NF
›Surgical debridement is primary therapy; antibiotics adjunctive
›Antibiotics to AVOID for marine wound infections
›Penicillin and ampicillin
›Most marine bacteria are resistant
›Erythromycin
›Inadequate coverage for marine pathogens
›First-generation cephalosporins (e.g., cephalexin)
›Insufficient activity against Vibrio and marine gram-negatives
›M. marinum treatment
›Clarithromycin plus ethambutol
›Clarithromycin 500 mg PO twice daily
›Primary agent for M. marinum
›Ethambutol 15 mg/kg PO daily
›Companion agent to prevent resistance
›Duration 3 to 6 months; extend to 12 months if deep tissue involved
›Alternative regimens for M. marinum
›Rifampin 600 mg PO daily plus ethambutol
›Use when clarithromycin not tolerated
›Doxycycline 100 mg PO twice daily plus ethambutol
›Alternative two-drug regimen for susceptible strains
›Surgical debridement often required for deep M. marinum infections
›Tenosynovitis involving tendon sheaths
›Osteomyelitis
›Tetanus immunization
›Tetanus prophylaxis mandatory for all coral wounds
›Marine wounds are high tetanus risk (contaminated wound)
›Regardless of wound size or apparent severity
›Tetanus toxoid-containing vaccine if not up to date
›Td or Tdap for adults not vaccinated within 5 years for contaminated wounds
›Tdap preferred if prior Tdap history incomplete
›Tetanus immune globulin (TIG) if unvaccinated or unknown status
›TIG 250 units IM at separate site from vaccine
›Administer for high-risk wounds when vaccination status uncertain
›Analgesia
›NSAIDs as first-line for wound pain
›Ibuprofen 400 to 600 mg PO every 6 to 8 hours
›Naproxen 500 mg PO twice daily as alternative
›Acetaminophen for adjunct or NSAID contraindication
›1000 mg PO every 6 to 8 hours
›Topical lidocaine for fire coral sting pain
›Lidocaine 2% gel topically before nematocyst removal
›Limit area of application