Management of Wound Infections Following Animal and Human Bites | |||||
| BITING SPECIES | COMMONLY ISOLATED PATHOGENS | PREFERRED ANTIBIOTIC(S)a | ALTERNATIVE IN PENICILLIN-ALLERGIC PT | PROPHYLAXIS ADVISED FOR EARLY UNINFECTED WOUNDS | OTHER CONSIDERATIONS |
|---|---|---|---|---|---|
| Dog | Staphylococcus aureus, Pasteurella multocida, anaerobes, Capnocytophaga canimorsus | Amoxicillin/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) | Sometimesb | Consider rabies prophylaxis. |
| Cat | P. multocida, S. aureus, anaerobes | Amoxicillin/clavulanate or ampicillin/sulbactam as above | Clindamycin plus TMP-SMX as above or a fluoroquinolone | Usually | Consider rabies prophylaxis. Carefully evaluate for joint/bone penetration. |
| Human, occlusional | Viridans streptococci, S. aureus, Haemophilus influenzae, anaerobes | Amoxicillin/clavulanate or ampicillin/sulbactam as above | Erythromycin (500 mg PO qid) or a fluoroquinolone | Always | |
| Human, clenched-fist | As for occlusional, plus Eikenella corrodens | Ampicillin/sulbactam as above or imipenem (500 mg q6h) | Cefoxitinc | Always | Examine for tendon, nerve, or joint involvement. |
| Monkey | As for human bite | As for human bite | As for human bite | Always | For macaque monkeys, consider B virus prophylaxis with acyclovir. |
| Snake | Pseudomonas aeruginosa, Proteus spp., Bacteroides fragilis, Clostridium spp. | Ampicillin/sulbactam as above | Clindamycin plus TMP-SMX as above or a fluoroquinolone | Sometimes, especially with venomous snakes | Administer antivenin for venomous snakebite. |
| Rodent | Streptobacillus moniliformis, Leptospira spp., P. multocida | Penicillin VK (500 mg PO qid) | Doxycycline (100 mg PO bid) | Sometimes | |
| Aquatic animal (alligator, piranha, shark, moray eel, barracuda) | Aeromonas hydrophila, marine Vibrio spp. (Vibrio vulnificus) | Third-generation cephalosporin (e.g., ceftriaxone, 1 g IV q24h) plus doxycycline (100 mg PO bid) | Clindamycin plus levofloxacin (750 mg PO qd) plus doxycycline | Always | Obtain prompt surgical consultation, as risk for necrotizing infection is high with Aeromonas and Vibrio spp. |
a Antibiotic 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.
b Prophylactic 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.
c May be hazardous in pts with immediate-type hypersensitivity to penicillin.
Abbreviations: DS, double-strength; TMP-SMX, trimethoprim-sulfamethoxazole.