I irrigated and debrided the wound extensively, applied a topical antiseptic solution, and sutured the skin using 4 x interrupted sutures. I was concered about a significant risk of infection given the wound location, tissue damage, and initial contamination. At that point I dispensed a course of flucloxacillin (an antibiotic) in a standard dose (500 milligrams 4 times a day for 3 days with a goal of preventing infection). I gave Martin standard wound care advice, and planned to follow him up in 2 days March 10th 2019 at around 10 am, I reviewed Martin’s wound. At that point, he had a clearly established serious infection surrounding the wound, despite the prophylactic antibiotics. This infection had developed over the last 24 hours. I removed 2 of the sutures, draining a small amount of pus, and irrigated and further debrided the wound. A higher dose of antibiotic was clearly indicated, as the infection was significant enough be life or limb threating if left unchecked. My standard practice in a case like this is to give a higher dose of flucloxacillin in combination with a medicine called probenicid. In this case, probenicid acts to reduce the excretion of penicillin type antibiotics from the kidneys, thus boosting the blood levels of antibiotic. These higher levels of antibiotic are particularly important for treating serious infection, and I do not believe Martins infection would have resolved without them. The only other option would have been hospitalisation for intravenous antibiotics, which carries its own set of risks and costs, and would not necessarily be more effective than adding probenicid. 

I provided Martin with a prescription for 2 grams of flucloxacillin 3 times a day for the next 2 days (dropping to 1 gram 3 times a day for a further 5 days), and probenicid 500 milligrams 3 times a day for 7 days. I discussed all of this with Dr Julian Balance, an Orthopaedic Surgeon also volunteering as a race doctor. He agreed with the management plan as above. 

 slocyclist (14 hours ago)

 Opinions are like a*sholes, everyone has one. I'm a board-certified Emergency Medicine Doctor, so let's just stick to what makes sense medically, as well as what does not seem to add up.

Before we get to the medical part, let's look at the duck test, as this is often taught in medical school in the effort to teach the student to keep the most likely diagnoses at the top of the list. It goes like this, «if it looks like a duck, swims like a duck and quacks like a duck, then it's probably a duck.» One can easily extrapolate this to, «if it looks like bullshit, smells like bullshit and sounds like bullshit, it's probably bullshit.» This is the first thing that comes to my mind after I read yet another positive doping test in cycling (or any endurance sport). Yup, I'm looking at you Richie. 

Now for Mr. Maes. The biggest problem with the 'story' is that medically speaking it doesn't add up. If I see someone in the ER with a laceration that I'm concerned about enough to start them on a prophylactic (preventative) antibiotic, and then they come back with a «serious, limb threatening infection», the treatment indicated at that point would NEVER be to just add probenecid in an attempt to raise the serum concentration of that same antibiotic. A FIRST YEAR EMERGENCY MEDICINE INTERN would know that the correct treatment would ALWAYS be to expand antibiotic coverage because at that point you must conclude that the responsible bacteria may not be sensitive to the initial antibiotic. The main culprit here being a form of staph known as MRSA. Flucoxacillin does NOT cover MRSA and any ER doctor (hell any medical student) knows this. The correct action at that time is ALWAYS to either add an additional antibiotic that covers MRSA or stop the initial antibiotic and switch to a broad spectrum antibiotic (a bigger gun) that does cover it. This is not subjective and this is not opinion, it's basic medical knowledge. 
There are other smaller medical parts as well that don't add up (we don't put sutures in wounds that are «grossly contaminated»), but the first main point above regarding the antibiotics is enough to know that the duck test, although being a simple concept, is highly accurate once again.