Sandbox/Bites

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2]

Cellulitis Microchapters
Home
Patient Information
Overview
Historical perspective
Classification
Pathophysiology
Causes
Differentiating Cellulitis from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic study of choice
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
MRI
Ultrasound
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Sandbox/Bites On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Sandbox/Bites All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Sandbox/Bites
CDC on Sandbox/Bites
Sandbox/Bites in the news
Blogs on Sandbox/Bites
Directions to Hospitals Treating Cellulitis
Risk calculators and risk factors for Sandbox/Bites

Human Bites

Medical Therapy

▸ Click on the following categories to expand treatment regimens.

Human Bites   ▸  Adults   ▸  Children   ▸  '   ▸  '   ▸  Insect Bites

Early (not yet infected) Preferred Regimen ▸ Amoxicillin-clavulanate 875/125 mg orally q12h X 5 days Alternative Regimen (beta-lactam allergy) ▸ Moxifloxacin 400 mg orally q6h AND Clindamycin 300 mg orally q6h OR ▸ Trimethoprim-sulfamethoxazole 1 double-strength tablet orally q12h AND metronidazole 250 to 500 mg orally q6h Late (infected) Preferred Regimen ▸ Ampicillin sulbactam 1.5 gm IV q6h OR ▸ Cefoxitin 2 gm IV q8h OR ▸ Ticarcillin clavulanate 3.1 gm IV q6h OR ▸ Piperacillin-tazobactam 3.375 gm IV q6h or 4.5 gm q8h or 4-hr infusion of 3.375 gm q8h Alternative Regimen (beta-lactam allergy) ▸ Clindamycin 1.5 gm IV q6h PLUS ▸ Moxifloxacin 400 mg IV q6h Early (not yet infected) Preferred Regimen ▸ Amoxicillin-clavulanate (> 12weeks) 45 mg/kg/day orally in 2 divided doses for 5 days Late (infected) Preferred Regimen ▸ Ampicillin sulbactam 100 to 300 mg/kg/day IV q6h OR ▸ Cefoxitin 80 to 160 mg/kg/day IV in 4 divided doses OR ▸ Ertapenem (3months - 12years) 15 mg/kg IV twice daily (maximum 1 g/day) OR Ertapenem (>13years) 1 g IV once daily Rat Preferred Regimen ▸ Amoxicillin-clavulanate 875/125 mg orally q12h X 5 days Pig (Swine) Preferred Regimen ▸ Amoxicillin-clavulanate 875/125 mg orally q12h X 5 days Alternative Regimen ▸ Ampicillin sulbactam OR ▸ Imipenem OR ▸ Cephalosporin Oral Regimen ▸ Clindamycin 5 mg/kg orally q8h OR ▸ Linezolid 10 mg/kg orally q8-12h Parental Regimen ▸ Vancomycin 10 to 15 mg/kg IV q8-12h PLUS ▸ Cefotaxime 50 mg/kg IV q8h OR ▸ Gentamicin 2.5 mg/kg IV q8-12h Oral Regimen ▸ Clindamycin 5 mg/kg orally q8h OR ▸ Linezolid 10 mg/kg orally q8h Parental Regimen ▸ Vancomycin 10 to 15 mg/kg IV q6-8h PLUS ▸ Cefotaxime 50 mg/kg IV q6-8h OR ▸ Gentamicin 2.5 mg/kg IV q8h Oral Regimen ▸ Clindamycin 5 mg/kg orally q6h OR ▸ Linezolid 10 mg/kg orally q8h

Vaccination

• Diphtheria, Tetanus, and Acellular Pertussis Vaccine:
  • Adults (19 years and older, including pregnant women): 1 dose (0.5 mL) IM once to replace a single dose of tetanus and diphtheria (Td) for adults who have not received a prior dose of Tdap
  • Pediatrics (13 to 18 years, catch-up): 1 dose (0.5 mL) IM to those who missed the 11- to 12-year Tdap booster dose if they have completed the recommended childhood DTP/DTaP vaccination series
  • Pediatrics (11 to 12 years): 1 dose (0.5 mL) IM to those who have completed the recommended childhood DTP/DTaP vaccination series and have not received a Tdap booster dose

• Diphtheria and Tetanus Toxoids:
  • Adults (19 years and older): 1 dose (0.5 mL) Td IM every 10 years for persons who previously received a one-time dose of Tdap

Dog Bites

Medical Therapy

▸ Click on the following categories to expand treatment regimens.

Dog Bites   ▸  Adults   ▸  Children

Early (not yet infected) Preferred Regimen ▸ Amoxicillin-clavulanate 875/125 mg orally q12h OR ▸ Amoxicillin-clavulanate 500/125 mg orally q8h Alternative Regimen (beta-lactam allergy) ▸ Clindamycin 300 mg orally q6h PLUS ▸ Ciprofloxacin 500 to 750 mg orally q12h Late (infected) Preferred Regimen ▸ Ampicillin sulbactam 1.5 to 3 g IV q6-8h OR ▸ Piperacillin-tazobactam 3.375 gm IV q6-8h OR ▸ Ertapenem 1 gm IV q24h OR ▸ Imipenem-Cilastin 1 gm IV q6-8h OR ▸ Imipenem-Cilastin 1 gm IV q6-8h OR ▸ Meropenem 1 gm IV q8h Alternative Regimen (beta-lactam allergy) ▸ Cefazolin 1 gm IV q8h OR ▸ Cefuroxime 1 gm IV q24h OR ▸ Cefoxitin 1 gm IV q6-8h OR ▸ Ceftriaxone sodium 1 gm IV q12h OR ▸ Cefotaxime 2 gm IV q6h OR ▸ Ciprofloxacin 400 mg IV q12h OR ▸ Moxifloxacin 400 mg IV q24h Early (not yet infected) Preferred Regimen ▸ Amoxicillin-clavulanate 45 mg/kg/day orally in two divided doses X 3-7 days Alternative Regimen (beta-lactam allergy) ▸ Clindamycin 20 to 30 mg/kg/day orally in 4 divided doses PLUS ▸ Trimethoprim component 8 mg/kg/day orally in 2 divided doses Late (infected) Preferred Regimen ▸ Ampicillin sulbactam 100 to 300 mg/kg/day IV q6h OR ▸ Cefoxitin 80 to 160 mg/kg/day IV in 4 divided doses OR ▸ Ertapenem (3months - 12years) 15 mg/kg IV twice daily (maximum 1 g/day) OR Ertapenem (>13years) 1 g IV once daily

Vaccination

• Unvaccinated patients exposed to an animal suspected of having rabies:
  • Adults: Rabies immune globulin 20 International Units/kg IM; infiltrate as much as possible of the full dose around wound(s); give the remainder IM at an anatomic site distant from vaccine administration AND rabies vaccine 1 mL IM in deltoid region as soon as possible after exposure; repeat rabies vaccine dose on days 3, 7, 14, and 28
  • Pediatrics: Rabies immune globulin 20 International Units/kg IM; infiltrate as much as possible of the full dose around wound(s); give the remainder IM at an anatomic site distant from vaccine administration AND rabies vaccine 1 mL IM in lateral thigh as soon as possible after exposure; repeat rabies vaccine dose on days 3, 7, 14, and 28

• Vaccinated patients exposed to animals suspected of having rabies:
  • Adults: 1 mL rabies vaccine IM in deltoid region as soon as possible after exposure; repeat dose 3 days later
  • Pediatrics: 1 mL rabies vaccine IM in lateral thigh as soon as possible after exposure; repeat dose 3 days later

Cat Bites

Medical Therapy

▸ Click on the following categories to expand treatment regimens.

Cat Bites   ▸  Adults   ▸  Children

Early (not yet infected) Preferred Regimen ▸ Amoxicillin-clavulanate 875/125 mg orally q12h OR ▸ Amoxicillin-clavulanate 500/125 mg orally q8h Alternative Regimen (beta-lactam allergy) ▸ Doxycycline 100 mg orally q12h OR ▸ Cefuroxime 500 mg orally q12h Late (infected) Preferred Regimen ▸ Ampicillin sulbactam 1.5 to 3 g IV q6-8h OR ▸ Piperacillin-tazobactam 3.375 gm IV q6-8h OR ▸ Ertapenem 1 gm IV q24h OR ▸ Imipenem-Cilastin 1 gm IV q6-8h OR ▸ Imipenem-Cilastin 1 gm IV q6-8h OR ▸ Meropenem 1 gm IV q8h Alternative Regimen (beta-lactam allergy) ▸ Cefazolin 1 gm IV q8h OR ▸ Cefuroxime 1 gm IV q24h OR ▸ Cefoxitin 1 gm IV q6-8h OR ▸ Ceftriaxone sodium 1 gm IV q12h OR ▸ Cefotaxime 2 gm IV q6h OR ▸ Ciprofloxacin 400 mg IV q12h OR ▸ Moxifloxacin 400 mg IV q24h Cat scratch disease Preferred Regimen ▸ Azithromycin 500 mg orally on day 1, then 250 mg orally once daily X 4 days Early (not yet infected) Preferred Regimen ▸ Amoxicillin-clavulanate 45 mg/kg/day orally in two divided doses X 3-7 days Alternative Regimen ▸ Cefuroxime 10 to 15 mg/kg orally q12h Cat scratch disease Preferred Regimen ▸ Azithromycin 10 mg/kg orally on day 1, then 5 mg/kg orally X 4 days Late (infected) Preferred Regimen ▸ Ampicillin sulbactam 100 to 300 mg/kg/day IV q6h OR ▸ Cefoxitin 80 to 160 mg/kg/day IV in 4 divided doses OR ▸ Ertapenem (3months - 12years) 15 mg/kg IV twice daily (maximum 1 g/day) OR Ertapenem (>13years) 1 g IV once daily

Monkey Bites

Medical Therapy

▸ Click on the following categories to expand treatment regimens.

Monkey Bites   ▸  Adults   ▸  Children

High risk bites (deep bites, symptomatic animals 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 High risk bites (deep bites, symptomatic animals 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

Rat Bites

Medical Therapy

▸ Click on the following categories to expand treatment regimens.

Rat Bites   ▸  Adults   ▸  Children

Uncomplicated Preferred Regimen ▸ Amoxicillin-clavulanate 875/125 mg orally q12h Alternative Regimen (beta-lactam allergy) ▸ Doxycycline 100 mg orally q12h Rat bite fever 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 Early (not yet infected) Preferred Regimen ▸ Amoxicillin-clavulanate 45 mg/kg/day orally in two divided doses X 3-7 days Alternative Regimen ▸ Cefuroxime 10 to 15 mg/kg orally q12h Rat bite fever Preferred Regimen ▸ Penicillin G benzathine 25,000 to 50,000 units/day IM X 10-14 days OR ▸ Tetracycline (>8 years) 25 to 50 mg/kg/day orally in 4 divided doses X 10-14 days Alternative Regimen ▸ Streptomycin 15 mg/kg/day IM in a single dose or in 2 divided doses X 10-14 days

References

Template:WikiDoc Sources