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Table 27-1

Management of Wound Infections Following Animal and Human Bites

Biting SpeciesCommonly Isolated PathogensPreferred Antibiotic(s)aAlternative in Penicillin-Allergic PtProphylaxis Advised for Early Uninfected WoundsOther Considerations
DogStaphylococcus aureus, Pasteurella multocida, anaerobes, Capnocytophaga canimorsusAmoxicillin/clavulanate (250-500 mg PO tid) or ampicillin/sulbactam (1.5-3.0 g IV q6h)Clindamycin (150-300 mg PO qid) plus either TMP-SMX (1 DS tablet PO bid) or ciprofloxacin (500 mg PO bid)SometimesbConsider rabies prophylaxis.
CatP. multocida, S. aureus, anaerobesAmoxicillin/clavulanate or ampicillin/sulbactam as aboveClindamycin plus TMP-SMX as above or a fluoroquinoloneUsuallyConsider rabies prophylaxis. Carefully evaluate for joint/bone penetration.
Human, occlusionalViridans streptococci, S. aureus, Haemophilus influenzae, anaerobesAmoxicillin/clavulanate or ampicillin/sulbactam as aboveErythromycin (500 mg PO qid) or a fluoroquinoloneAlways
Human, clenched-fistAs for occlusional, plus Eikenella corrodensAmpicillin/sulbactam as above or imipenem (500 mg q6h)CefoxitincAlwaysExamine for tendon, nerve, or joint involvement.
MonkeyAs for human biteAs for human biteAs for human biteAlwaysFor macaque monkeys, consider B virus prophylaxis with acyclovir.
SnakePseudomonas aeruginosa, Proteus spp., Bacteroides fragilis, Clostridium spp.Ampicillin/sulbactam as aboveClindamycin plus TMP-SMX as above or a fluoroquinoloneSometimes, especially with venomous snakesAdminister antivenin for venomous snakebite.
RodentStreptobacillus moniliformis, Leptospira spp., P. multocidaPenicillin VK (500 mg PO qid)Doxycycline (100 mg PO bid)Sometimes

aAntibiotic choices should be based on culture data when available. These suggestions for empirical therapy need to be tailored to individual circumstances and local conditions. IV regimens should be used for hospitalized pts. A single IV dose of antibiotics may be given to pts who will be discharged after initial management.

bProphylactic antibiotics are suggested for severe or extensive wounds, facial wounds, and crush injuries; when bone or joint may be involved; and when comorbidity is present (see text).

cMay be hazardous in pts with immediate-type hypersensitivity to penicillin.

Abbreviations: DS, double-strength; TMP-SMX, trimethoprim-sulfamethoxazole.