In a patient with a burn wound on the hand showing redness, crusting, and leaking yellow pus, who is allergic to macrolide antibiotics, what is the most appropriate antibiotic treatment?

• A. Flucloxacillin
• B. Doxycycline
• C. Clarithromycin
• D. Amoxicillin

Answer: (B)

Infected burn wounds need an antibiotic that effectively covers the common skin pathogens, especially Staphylococcus aureus, and is safe given the patient’s allergy. Clarithromycin is a macrolide, so it must be avoided because of the allergy. Doxycycline is a good choice here because it provides reliable activity against Staphylococcus aureus, including many strains encountered in skin and soft tissue infections, and it penetrates well into tissues. This makes it a suitable option when a macrolide is off limits.

Flucloxacillin targets MSSA well but may be ineffective if MRSA is involved, which is a real concern in burn wound infections. Amoxicillin has limited usefulness against Staphylococcus aureus due to beta-lactamase enzymes produced by these bacteria. So, given the allergy and the need to cover potential MRSA in a burn wound, doxycycline stands out as the most appropriate choice.