Sandbox/Bites

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

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Empiric Therapy

▸ Click on the following categories to expand treatment regimens.

[1]

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
Monkey bite
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
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

Human Bites

  • 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 [7] every 10 years for persons who previously received a one-time dose of Tdap

▸ Click on the following categories to expand treatment regimens.

[1]

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

References

  1. 1.0 1.1 Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ; et al. (2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clin Infect Dis. 41 (10): 1373–406. doi:10.1086/497143. PMID 16231249.


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