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Revision as of 19:38, 11 June 2014

Treatment

Bite wounds are washed, ideally with povidone-iodine soap and water. The injury is then loosely bandaged, but is not sutured due to risk of infection.

Animal bites inflicted by carnivores (other than rodents) are considered possible cases of rabies. The animal is caught alive or dead with its head preserved, so the head can later be analyzed to detect the disease. Signs of rabies include foaming at the mouth, self-mutilation, growling, jerky behavior, and red eyes. If the animal lives for ten days and does not develop rabies, then it is probable that no infection has occurred.

If the animal is gone, prophylactic rabies treatment is recommended in most places. Certain places, such as Hawaii, Australia and the United Kingdom, are known not to have native rabies. Treatment is generally available in North America and the Northern European states.

Antibiotic Therapy

Antibiotic Prophylaxis

  ▸  Animal Bite

Antibiotic Prophylaxis
Preferred Regimen
Amoxicillin-clavulanate 500-875/125 PO q8-12h
Alternative Regimen
Clindamycin 300 mg q8h
OR
Metronidazole 500 mg PO q8h
PLUS
Doxycycline 100 mg q12h
OR
TMP-SMX 160/800 mg PO q12h
OR
Penicillin VK 500 mg PO q6h
OR
Cefuroxime 500 mg PO q12h
OR
Moxifloxacin 400 mg PO q24h


Specific Therapy

  ▸  Human Bite

  ▸  Dog Bite

  ▸  Cat Bite

  ▸  Pig (Swine) 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 PO q12h
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
OR
Ticarcillin clavulanate 3.1 g IV q6hr
Monkey Bite - Adults
(Herpesvirus simiae, B Virus) [1]

Profilaxis
Valacyclovir 1 g PO q8h x 14 days
OR
Acyclovir 800 mg PO 5 times/day
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 Rat Bite
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
Snake Bite - Adults
Preferred Regimen
[[
Alternative Regimen
[[
OR
[[
Seal Bite - Adults
Preferred Regimen
[[A
Alternative Regimen
[[C
OR
[[D
Spider Bite - Adults
Preferred Regimen
[[
Alternative Regimen
[[C
OR
[[D
Bat, Racoon or Skunk Bite - Adults
Preferred Regimen
[[A
Alternative Regimen
[[C
OR
[[Do

Vaccination

References

  1. Cohen, Jeffrey I.; Davenport, David S.; Stewart, John A.; Deitchman, Scott; Hilliard, Julia K.; Chapman, Louisa E. (2002). "Recommendations for Prevention of and Therapy for Exposure to B Virus (Cercopithecine Herpesvirus1)". Clinical Infectious Diseases. 35 (10): 1191–1203. doi:10.1086/344754. ISSN 1058-4838.