The medical management choices are a bit different than we'd see here in the USA, and it does bring up some questions. I wonder why he sutured closed an infected wound? If the wound was limb-threatening then I wonder why they didn't send him to the hospital to debride it in the O.R. then follow up with IV antibiotics? Probenecid is usually used as a gout medication, and the article states he prescribed it two days later. Wouldn't he have returned to a place with internet access by then, or was he still out at the race venue? I think IV antibiotics and surgical debridement is what would've happened stateside. That's interesting.
It wasn't infected when he sutured it closed.
My understanding from the article and the posted letter from the doctor is that on the recheck (when the infection was first discovered) 2 days after the injury was initially treated, sending him to the hospital for their treatment protocol would have required a costly evac procedure, as they were still out in the boonies. The doctor stated further that in the absence of any additional info about banned drugs (due to no cell reception/internet), he felt that his protocol was at least as effective as what the hospital would do, anyway (with IV antibiotics). In his letter, he stated that he would do what he did again given the same situation.
It sounded like the race in which this occurred was a multi-day event and the initial laceration happened fairly early. It was cleaned up, sutured, and Maes was given prophylactic antibiotics. But because the race was really muddy, the wound got contaminated and infected in spite of the antibiotics. Seems to me like some kind of waterproof dressing would have been a good idea, but what do I know, I only have Wilderness First Aid training. Either way, after 2 days, the wound had become infected (must have been a bad one if the doctor was worried about loss of the limb) and it needed additional, more aggressive treatment. The doctor was equipped to treat it a little more aggressively than he had before (with a higher dose of antibiotics and some additional drugs) and opted to do so rather than calling for an evac.
What you say about what would have happened stateside is probably true. Partly because except for a few places, getting him to a hospital would probably have been a bit easier. But, there's a reason why the race in question had multiple doctors on hand with the ability to treat something like this without an evac in the first place.
