NO DRUG THERAPY IN PRIMARY CARE (ASSESS FIRST)
Most splinters are removed, not medicated. Settle three questions first. Can the whole object be seen and reached? Is it organic - wood, thorn, spine - in which case it must come out, because organic material always becomes infected? Is it glass or metal, which may sit far deeper than the entry wound suggests and should be x-rayed? Then check tetanus cover. - Assess, then decide
In a small child, weigh the distress of digging for a tiny superficial splinter against letting it work its own way out. Anything organic, and anything driven into the foot through a shoe, still has to come out.
No dose - assessment step, no medicine given
The harm here comes from leaving part of the object behind or missing a deeper injury, not from choosing the wrong drug. Getting the assessment right is the treatment.
- Wounds contaminated with soil, saliva or manure, and every puncture wound, are tetanus-prone. Check the immunisation history and complete it - assume nothing about adult booster status.
- Refer rather than explore: glass or metal whose end you cannot see, anything near a tendon, joint, artery or nerve, anything in the eye or face, and any foreign body in a diabetic or ischaemic foot.
- A puncture wound through a training shoe is the classic route to Pseudomonas osteomyelitis of the foot. Have a low threshold for referral if it stays painful.
- Irrigate copiously with clean running water or saline. The volume of irrigation matters more than which antiseptic is used.
- There is no routine indication for a prophylactic antibiotic in a simple splinter that has been fully removed and cleaned. Treat infection if it develops.
- A retained fragment presents later as a persistent tender lump, a sinus that keeps discharging, or a wound that will not heal. Consider ultrasound - it shows wood and thorn, which x-ray does not.