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Environmental exposure antibiotics
From WikEM
Contents
Mammalian bites
Cat and Dog Bites
Coverage for Pasteurella, Strep, and Staph
- Consider for high-risk wounds
- wounds reaching the level of the muscle/tendon, wounds to the hand[1], violation of bone or joint capsule, immunocompromised hosts, wounds associated with significant local edema
- Amoxicilin-clavulanate 875mg PO BID x 5-7 days OR[2]
- Doxycycline 100mg PO daily x 14 days if penicillin allergic [3]
- Clindamycin 450mg (5mg/kg) PO q8hrs daily x7 days PLUS
- Ciprofloxacin 500mg PO q12hrs x 7 days OR
- TMP/SMX 2DS tabs (5mg/kg) PO q12hrs
Human Bites
All human bites should be strongly considered for antibiotic therapy.[4]
Requires polymicrobial coverage for: S. aureus, Strep Viridans, Bacteroides, Coagulase-neg Staph, Eikenella, Fusobacterium, Cornebacterium, Peptostreptococcus
- Amoxicilin-clavulanate 875mg PO BID x 5-7days OR
- Clindamycin 450mg (5mg/kg) PO q8hrs daily x7 days PLUS
- Ciprofloxacin 500mg PO q12hrs x 7 days OR
- TMP/SMX 2DS tabs (5mg/kg) PO q12hrs
Mammalian Bites Severe Infections
- Ampicillin/Sulbactam 3g IV (50mg/kg IV) q 6hrs daily OR
- Cefoxitin 1g IV q8hrs (25mg/kg q6hrs) OR
- Pipericillin/Tazobactam 4.5g IV (80mg/kg IV) q8hrs OR
- Ceftriaxone 1g (50mg/kg IV) once + Metronidazole 500mg IV q8hrs OR
- Clindamycin 600mg IV q8hrs PLUS
- TMP/SMX 5mg/kg IV q12hrs OR
- Ciprofloxacin 400mg IV q12hrs OR
Tetanus (Acute)
- Metronidazole 500mg IV (7.5mg/kg) q6hrs OR
- Clindamycin 600mg IV (7.5mg/kg) q6hrs
Penicillin
- Although once the drug of choice it is now no longer recommended since it may potentiate the effect of tetanus toxin by inhibiting the GABA receptors[5]
See Also
Antibiotics by diagnosis
- Bone and joint antibiotics
- Cardiovascular antibiotics
- ENT antibiotics
- Eye antibiotics
- GI antibiotics
- GU antibiotics
- Neuro antibiotics
- OB/GYN antibiotics
- Pulmonary antibiotics
- Skin and soft tissue antibiotics
- Bioterrorism antibiotics
- Environmental exposure antibiotics
- Immunocompromised antibiotics
- Post exposure prophylaxis antibiotics
- Pediatric antibiotics
- Sepsis antibiotics
- Arthropod and parasitic antibiotics
For antibiotics by organism see Microbiology (Main)
References
- ↑ EBQ:Antibiotic prophylaxis for mammalian bites
- ↑ Griego RD, Rosen T, Orengo IF, Wolf JE. Dog, cat, and human bites: a review. J Am Acad Dermatol. 1995;33:1019–29.
- ↑ Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med. 1999;340:85–92.
- ↑ EBQ:Antibiotic prophylaxis for mammalian bites
- ↑ Ganesh Kumar AV. Benzathine penicillin, metronidazole and benzyl penicillin in the treatment of tetanus: a randomized, controlled trial .Ann Trop Med Parasitol. 2004 Jan;98(1):59-63 PMID 15000732
