Sandbox/Alejandro

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 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 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 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 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 / Primate Bite (Herpesvirus simiae, B Virus) 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 Adapted from Prevention of and Therapy for B Virus Exposure • CID 2002:35 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 400,000 - 600,000 IU/day IV x 10-14 days (dose should be increased to 1.2 M if no clinical response) Alternative Regimen ▸ Streptomycin 15 mg/kg/day IM divided q12-24h x 10-14 days OR ▸ Tetracycline 250 to 500 mg orally q6h Adapted from Clin. Microbiol. Rev. January 2007 vol.20 no.1 13-22 Snake Bite Preferred Regimen ▸ [[ Alternative Regimen ▸ [[ OR ▸ [[ Seal Bite Preferred Regimen ▸ Tetracycline 1.5 g 1 dose, then 0.5 g q6h x 4-6 weeks Alternative Regimen ▸ Doxycycline 100 mg q12h x 4-6 weeks Adapted from Journal of Infection (2002) 45: 71±75 Spider Bite Preferred Regimen ▸ [[ Alternative Regimen ▸ [[C OR ▸ [[D Bat, Racoon or Skunk Bite Preferred Regimen ▸ Amoxicillin-clavulanate 875/125 mg orally q12h Alternative Regimen ▸ Doxycycline 100 mg orally q12h