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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Streptomycin]] 15 mg/kg/day IM in a single dose or in 2 divided doses X 10-14 days'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Streptomycin]] 15 mg/kg/day IM in a single dose or in 2 divided doses X 10-14 days'''''
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{|
| valign=top |
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Children'''
</font>
</div>
<div class="mw-customtoggle-table10" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Human Bite'''
</font>
</div>
<div class="mw-customtoggle-table11" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Dog Bite'''
</font>
</div>
<div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Cat Bite'''
</font>
</div>
<div class="mw-customtoggle-table13" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Pig Bite'''
</font>
</div>
<div class="mw-customtoggle-table14" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Monkey Bite'''
</font>
</div>
<div class="mw-customtoggle-table15" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Rat Bite'''
</font>
</div>
| valign=top |
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table10" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Human Bite (Children)}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin sulbactam]] 100 to 300 mg/kg/day IV q6h'''''<BR> OR <BR> ▸ '''''[[Cefoxitin]] 80 to 160 mg/kg/day IV in 4 divided doses'''''<BR> OR <BR> ▸ '''''[[Ertapenem]] (3months - 12years) 15 mg/kg IV twice daily (maximum 1 g/day) OR [[Ertapenem]] (>13years) 1 g IV once daily'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table11" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center  | {{fontcolor|#FFF|Dog Bite (Children)}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin sulbactam]] 100 to 300 mg/kg/day IV q6h'''''<BR> OR <BR> ▸ '''''[[Cefoxitin]] 80 to 160 mg/kg/day IV in 4 divided doses'''''<BR> OR <BR> ▸ '''''[[Ertapenem]] (3months - 12years) 15 mg/kg IV twice daily (maximum 1 g/day) OR [[Ertapenem]] (>13years) 1 g IV once daily'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table12" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Cat Bite (Children)}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[ '''''
|-
|}
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{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table13" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Pig (Swine) Bite (Children)}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 875/125 mg orally q12h X 5 days'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin sulbactam]] 100 to 300 mg/kg/day IV q6h'''''<BR> OR <BR> ▸ '''''[[Imipenem cilastatin]] 1 g IV q6-8h'''''<BR> OR <BR> ▸ '''''[[Cephalosporin]]'''''
|-
|}
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{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table14" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|High risk bites (deep bites, symptomatic animals)<ref name="pmid2821376">{{cite journal| author=Centers for Disease Control (CDC)| title=Guidelines for prevention of Herpesvirus simiae (B virus) infection in monkey handlers. | journal=MMWR Morb Mortal Wkly Rep | year= 1987 | volume= 36 | issue= 41 | pages= 680-2, 687-9 | pmid=2821376 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2821376  }} </ref><ref name="pmid2160783">{{cite journal| author=Holmes GP, Hilliard JK, Klontz KC, Rupert AH, Schindler CM, Parrish E et al.| title=B virus (Herpesvirus simiae) infection in humans: epidemiologic investigation of a cluster. | journal=Ann Intern Med | year= 1990 | volume= 112 | issue= 11 | pages= 833-9 | pmid=2160783 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2160783  }} </ref>
}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen (without CNS symptoms)'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Acyclovir]]  12.5–15 mg per kg IV q8h'''''<BR> OR <BR> ▸ '''''[[Ganciclovir]] 5 mg per kg IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen (with CNS symptoms)'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ganciclovir]] 5 mg per kg IV q12h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table15" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Early (not yet infected)}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 45 mg/kg/day orally in two divided doses X 3-7 days'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefuroxime]] 10 to 15 mg/kg orally q12h'''''
|-
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Rat bite fever<ref name="pmid1562665">{{cite journal| author=Rupp ME| title=Streptobacillus moniliformis endocarditis: case report and review. | journal=Clin Infect Dis | year= 1992 | volume= 14 | issue= 3 | pages= 769-72 | pmid=1562665 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1562665  }} </ref>}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin G benzathine]] 25,000 to 50,000 units/day IM X 10-14 days'''''<BR> OR <BR> ▸ '''''[[Tetracycline]] (>8 years) 25 to 50 mg/kg/day orally in 4 divided doses X 10-14 days'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Streptomycin]] 15 mg/kg/day IM in a single dose or in 2 divided doses X 10-14 days'''''
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Revision as of 16:27, 11 June 2014

Adults

  ▸  Human Bite

  ▸  Dog Bite

  ▸  Cat Bite

  ▸  Pig Bite

  ▸  Monkey/ Primate Bite

  ▸  Rat Bite

  ▸  Snake Bite

  ▸  Seal Bite

  ▸  Spider Bite

  ▸  Bat, Racoon or Skunk Bite

Human Bite (Adults)
Preferred Regimen
Ampicillin sulbactam 1.5 g IV q6h
OR
Cefoxitin 2 gm IV q8h
OR
Ticarcillin clavulanate 3.1 g IV q6h
OR
Piperacillin-tazobactam 3.375 g IV q6-8h
Alternative Regimen (beta-lactam allergy)
Clindamycin 300 mg PO q8h
PLUS
Ciprofloxacin 500-750 mg IV q12h
OR
Moxifloxacin 400 mg IV q24h
OR
TMP-SMX 160/800 mg q12h
Dog Bite (Adults)
Preferred Regimen
Amoxicillin-clavulanate 500-875/125 PO q8-12h
Alternative Regimen (beta-lactam allergy)
Clindamycin 300 mg PO q8h
PLUS
Ciprofloxacin 500-750 mg IV q12h
OR
Moxifloxacin 400 mg IV q24h
OR
Gatifloxacin 400 mg q24h
Cat Bite (Adults)
Preferred Regimen
Amoxicillin-clavulanate 500-875/125 PO q8-12h
Alternative Regimen (beta-lactam allergy)
Cefuroxime 500 mg q12h
OR
Doxycycline 100 mg q12h
Pig (Swine) Bite (Adults)
Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h X 5 days
Alternative Regimen
Ampicillin sulbactam 1.5 to 3 g IV q6-8h
OR
Imipenem cilastatin 1 g IV q6-8h
OR
Ceftriaxone 1 g q12 h
OR
Cefotaxime 2 g q6 h
High risk bites (deep bites, symptomatic animals)[1][2]

Preferred Regimen (without CNS symptoms)
Acyclovir 12.5–15 mg per kg IV q8h
OR
Ganciclovir 5 mg per kg IV q12h
Preferred Regimen (with CNS symptoms)
Ganciclovir 5 mg per kg IV q12h
Uncomplicated
Preferred Regimen
Amoxicillin-clavulanate 875/125 mg orally q12h
Alternative Regimen (beta-lactam allergy)
Doxycycline 100 mg orally q12h
Rat bite fever[3]
Preferred Regimen
Penicillin G benzathine 600,000 to 1,000,000 units/day IM X 10-14 days
OR
Tetracycline 250 to 500 mg orally q6h
Alternative Regimen
Streptomycin 15 mg/kg/day IM in a single dose or in 2 divided doses X 10-14 days
  1. Centers for Disease Control (CDC) (1987). "Guidelines for prevention of Herpesvirus simiae (B virus) infection in monkey handlers". MMWR Morb Mortal Wkly Rep. 36 (41): 680–2, 687–9. PMID 2821376.
  2. Holmes GP, Hilliard JK, Klontz KC, Rupert AH, Schindler CM, Parrish E; et al. (1990). "B virus (Herpesvirus simiae) infection in humans: epidemiologic investigation of a cluster". Ann Intern Med. 112 (11): 833–9. PMID 2160783.
  3. Rupp ME (1992). "Streptobacillus moniliformis endocarditis: case report and review". Clin Infect Dis. 14 (3): 769–72. PMID 1562665.