Emergency Medicine Book

http://www.fpnotebook.com/

Infected Animal Bite

Aka: Infected Animal Bite, Infected Mammalian Bite, Dog Bite Infection, Infected Dog Bite, Infected Cat Bite
  1. See Also
    1. Dog Bite
    2. Cat Bite
    3. Animal Bite
    4. Human Bite
    5. Fight Bite
  2. Causes: Bacterial Infection
    1. See Animal Bite
    2. See Human Bite
    3. Pasteurella multocida (20-50% of all dog and Cat Bite infections)
      1. Typically Cat Bites, but can occur in Dog Bites as well
      2. Infection rapid onset (<24 hours) and progression is typical of P. multocida
    4. Pasteurella canis
      1. Resistant to Dicloxacillin, Cephalexin, Clindamycin and Erythromycin
    5. Streptococcus
    6. Staphylococcus aureus
    7. Escherichia coli
    8. Moraxella
    9. Corynebacterium
    10. Neisseria
    11. Anaerobic Bacteria
      1. Bacteroides
      2. Fusobacterium
      3. Peptostreptococcus
    12. Capnocytophaga canimorsus (DF-2)
      1. Emerging Infection in dog and Cat Bites with risk of secondary Sepsis, Meningitis, endocarditis, DIC, Acute Renal Failure
      2. Increased risk in patients s/p splenectomy or with Alcohol Abuse (or other immunocompromised state)
      3. Gram Negative Bacteria responds to Augmentin
  3. Risk Factors: Infection
    1. Wound Type
      1. Crush Injury
      2. Puncture Wound
      3. Hand Wound
    2. Underlying Disease
      1. Chronic Disease
      2. Chronic extremity edema
      3. Diabetes Mellitus
      4. Immunosuppression
      5. Liver disease
      6. Prior Mastectomy
      7. Prosthetic Valve
      8. Prosthetic Joint
      9. Asplenia (post-splenectomy)
      10. Systemic Lupus Erythematosus (SLE)
  4. Management: Outpatient antibiotics
    1. Antibiotic duration guidelines
      1. Prophylaxis after Dog Bite: 5-7 days
      2. Cellulitis Present: 10 to 14 days
    2. First Line antibiotics (adults and children)
      1. Amoxicillin-Clavulanate (Augmentin)
        1. Child: 45 mg/kg/day divided twice daily up to 875 mg twice daily
        2. Adult: 875 mg twice daily
    3. Alternative Antibiotics for Penicillin Allergic
      1. Adults
        1. Combination protocol: Doxycycline AND Clindamycin (or Metronidazole)
          1. Doxycycline 100 mg orally twice daily (do not use in pregnancy) AND
          2. Clindamycin 300 mg every 8 hours (or Metronidazole)
        2. Combination protocol: Clindamycin with Ciprofloxacin
          1. Clindamycin 300 mg every 8 hours AND
          2. Ciprofloxacin 500 mg twice daily (or other Fluoroquinolone)
        3. Combination protocol: Cefuroxime with Metronidazole
          1. Cefuroxime (Ceftin) 500 mg twice daily AND
          2. Metronidazole (Flagyl), 250 to 500 mg four times daily
        4. Combination protocol: Clindamycin with Trimethoprim-Sulfamethoxazole
          1. Clindamycin 300 mg every 8 hours AND
          2. Trimethoprim-Sulfamethoxazole (Bactrim, Septra) DS twice daily
        5. Combination protocol: Penicillin VK with Dicloxacillin
          1. Penicillin VK 500 mg 4 times daily AND
          2. Dicloxacillin 500 mg 4 times daily
      2. Pregnancy
        1. Azithromycin (Zithromax), 250 to 500 mg daily
        2. Monitor closely to high risk of treatment failure
      3. Children
        1. Combination protocol
          1. Clindamycin 10 to 25 mg per kg divided every 8 hours AND
          2. Trimethoprim-Sulfamethoxazole (Bactrim, Septra)
            1. Dose: 8 to 10 mg/kg/day (trimethoprim component) divided twice daily
    4. Alternative Antibiotics for questionable compliance
      1. Ceftriaxone (Rocephin) IM qd
  5. Management: Inpatient antibiotics
    1. Indications
      1. Systemic signs of infection (fever, chills...)
      2. Lymphangitis or Lymphadenitis
      3. Rapidly spreading Cellulitis
      4. Advancement of Cellulitis past one joint
      5. Tenosynovitis
      6. Septic Arthritis
      7. Osteomyelitis
      8. Nerve involvement
    2. First-Line Intravenous Antibiotics
      1. Unasyn (Ampicillin/Sulbactam) 3 g every 6 hours
    3. Second-Line Intravenous Antibiotics
      1. Piperacillin/Tazobactam 3.375 g every 6 hours
      2. Ceftriaxone 2 g every 24 hours AND Clindamycin 600-900 mg every 8 hours
      3. Trimethoprim/Sulfamethoxazole AND Clindamycin 600-900 mg every 8 hours
    4. Consultations to consider
      1. General Surgery
      2. Orthopedics
      3. Plastic surgery
  6. References
    1. Cowling and House (2017) Crit Dec Emerg Med 31(5): 15-20
    2. Gilbert (2017) Sanford Guide, accessed 5/9/2017
    3. Ellis (2014) Am Fam Physician 90(4):239-43 [PubMed]
    4. Presutti (2001) Am Fam Physician 63(8):1567-72 [PubMed]
    5. Presutti (1997) Postgrad Med 101:243 [PubMed]
    6. Talan (1999) N Engl J Med 340:85-92 [PubMed]

infected dog bite (C0850850)

Concepts Disease or Syndrome (T047)
English Infection;bite;dog, bite dog infection, bite dog infections, bites dog infections, infected dog bite
Sources
Derived from the NIH UMLS (Unified Medical Language System)


infected animal bite (C0850852)

Concepts Disease or Syndrome (T047)
English Infection;bite;animal, infected animal bite
Sources
Derived from the NIH UMLS (Unified Medical Language System)


You are currently viewing the original 'fpnotebook.com\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree