ANIMAL BITES
  • Polymicrobial
    • Mixed aerobes and anaerobes
    • Nonpurulent wounds generally staphylococci and streptococci
    • Pasteurella species common
  • Primary wound closure is not recommended with the exception of those to the face. Facial wounds should be irrigated immensely, and debride cautiously before closure
  • PREEMPTIVE ANTIBIOTIC THERAPY FOR CAT AND DOG BITES (WHICH ARE NOT CURRENTLY INFECTED)
    • Recommended for 3-5 day for patients who are:
      • Immunocompromised
      • Asplenic
      • Advanced liver disease
      • Preexisting or resultant edema around the area
      • Moderate to severe injuries especially to the hand or face
      • Injuries that penetrate the periosteum or joint capsule
  • Postexposure prophylaxis for rabies may be indicated. Check with local health officials for recommendations
  • Tetanus toxoid if indicated
  • RECOMMENDED ANTIBIOTIC THERAPY FOR INFECTED ANIMAL BITE WOUNDS
    • Amoxicillin/clavulanate 875/125 mg PO BID
    • Ampicillin/sulbactam 1.5 -3 gm IV q6-8hr
    • Piperacillin/tazobactam 3.375 gm IV q8hr
    • Cefuroxime 500 mg PO BID PLUS (metronidazole 500 mg PO TID OR clindamycin 300 mg PO QID)
    • Ceftriaxone 1 gm IV q12h PLUS (metronidazole 500 mg IV Q8hr OR clindamycin 600 mg IV q8hr)
    • Sulfamethazole/trimethoprim 800/160 mg PO BID PLUS (metronidzaole 500 mg PO TID OR clindamycin 300 mg PO QID)
    • Levofloxacin 750 mg PO daily PLUS (metronidazole 500 mg PO TID OR clindamycin 300 mg PO QID)
    • Levofloxacin 750 mg IV daily PLUS (metronidazole 500 mg IV q8hr OR clindamycin 600 mg IV q8hr)
    • Doxycycline 100 mg PO/IV q12hr (last line as some strep resistance seen) PLUS (metronidazole 500 mg IV/PO q8hr OR clindamycin 300 PO QID/clindamycin 600 mg IV q8hr)
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​HUMAN BITES
  • Polymicrobial
    • Aerobic bacteria - Streptococci, S. aureus, Eikenella corrodens​
    • Anaerobic bacteria - Fusobacterium, Peptostreptococcus, Prevotella, Porphyromonas species
  • RECOMMENDED ANTIBIOTIC THERAPY (ASSESS FOR MRSA RISK, MAY NEED TO ADD ANTI-MRSA AGENT AS WELL)
    • Amoxicillin/clavulanate 875/125 mg PO BID
    • Ampicillin/sulbactam 1.5- 3gm IV q6hr
    • Levofloxacin 750mg IV/PO q24hr PLUS (metronidazole 500 mg PO/IV q8hr OR clindamycin 300 mg PO QID/ clindamycin 600 mg IV q8hr)
    • Doxycycline 100 mg PO/IV q12hr PLUS (metronidazole  500 mg PO/IV q8hr OR clindamycin 300 mg PO QID/clindamycin 600 mg IV q8hr)