Antibiotic prophylaxis remains controversial.1,2 The use of antibiotics is left to the discretion of the Emergency Physician and should include consideration for the anatomic site of injury, depth of penetration, evidence of gross contamination, and factors that may compromise the patient's immunity (e.g., diabetes mellitus, HIV infection, steroid use, or malignancy). If antibiotic prophylaxis is chosen, prescribe a broad spectrum antibiotic such as trimethoprim-sulfamethoxazole or doxycycline. These will provide good coverage against gram-negative organisms typically associated with water recreation injuries, as well as some coverage against MRSA and other community acquired infections.7 Adding ciprofloxacin for pseudomonas coverage may also be considered, as pseudomonas and its subtypes are commonly found in soil and freshwater.6