Bite wounds antibiotics

Most bite wounds require antibiotic therapy only when clinical infection is present. However, prophylactic therapy is recommended for wounds at higher risk for infection. These include human bites, deep punctures, bites to the hand, and bites requiring surgical repair.43... 

The role of antimicrobials for noninfected dog bite wounds remains controversial because only 20% of wounds become infected. Antibiotic recommendations for empiric treatment include a 3- to 5-day course of therapy. Amoxicillin-clavulanic acid is commonly recommended for oral outpatient therapy. Alternative agents include doxycycline, or the combination of penicillin VK and dicloxaciHin. 

Wounds should be irrigated thoroughly with a copious volume (>150 mL) of sterile normal saline. Proper irrigation will reduce the bacterial count in the wound. Antibiotic or iodine solutions do not offer any advantage over saline and actually may increase tissue irritation. Several management techniques used in the treatment of bite wounds remain controversial these include the extent and type of debridement, the use of primary closure within 24 hours of the injury, and indications for the use of antibiotics. 

Controlled studies have not shown benefits definitively with prophylactic antibiotics for noninfected bites. Because up to 20% of bite wounds may become infected, a 3- to 5-day course of antimicrobial therapy generally is recommended. This is especially important for patients at greater risk for infection (patients older than 50 years of age and those with puncture wounds and wounds to the hands, and... 

For infected bite wounds, penicillin and a peniciUinase-resistant penicillin or amoxiciUin-clavulanic acid 875 mg/125 mg oraUy twice daily (40 mg/kg per day oraUy of the amoxicillin component divided into two doses) should be started empirically pending the culture results. Tetracyclines or a combination of clindamycin plus a fluoroquinolone or trimethoprim-sulfamethoxazole may be used as an alternative therapy for the penicillin-allergic patient. Hospitalization for minor wounds is not necessary if surgical repair of vital structures has not been performed. Patients suffering serious injuries or clenched-fist injuries should be started on intravenous antibiotics. Duration of therapy for infected bite injuries should be 7 to 14 days. 

Cummings P. Antibiotics to prevent infections in patients with dog bite wounds A meta-analysis of randomized trials. Ann Emerg Med 1994 23 535-540. 

Examples of common clinical situations in which nonsurgical antimicrobial prophylaxis is effective are given in Table 51-4. Nonsurgical prophylaxis, mentioned in earlier chapters, includes the prevention of CMV and HIV infections, influenza, meningococcal infections, and tuberculosis. Though somewhat less effective, antimicrobial prophylaxis is also commonly used for animal or human bite wounds and chronic bronchitis. Severely leukopenic patients are often given prophylactic antibiotics. 

Tea Tree (Melaleuca alternifolia) Uses Rx of superficial wounds (bacterial, viral, fungal, insect bites, minor burns, cold sores, acne Action Broad-spectrum antibiotic activity against E. coli, S. aureus, C. albicans Available forms Topical creams, lotions, oint, oil apply topically PRN Notes/SE Ataxia, contact dermatitis, D, drowsiness, GI mucosal irritation Interactions Effects OF drugs that affect histamine release EMS effects of Benadryl Valerian (Valeriana officinalis) Uses Anxiolytic, antispasmodic, dys-menorrheal, restlessness, sedative Action Inhibits uptake stimulates release of GABA, which T GABA concentration extracellularly causes sedation Available forms Ext 400-900 mg PO 30 min < hs, tea 2-3 g (1 tsp of crude herb) qid, PRN, tine 3-5 mL (1/2-1 tsp) (1 5 ratio) PO qid, PRN Efficacy Probably effective sedative (reduces sleep latency) Notes/SE GI upset, HA, insomnia, N/V, palpitations, restlessness, vision changes Interactions T Effects OF barbiturates, benzodiazepines, opiates, EtOH, catnip, hops, kavakava, passion flower, skullcap effects OF MAOIs, phenytoin, warfarin EMS T Effects of benzodiazepines and opiates abruptly D/C may cause withdrawal symptoms... 

Echinacea is without equal in the treatment of three conditions abnormal Papanicolaou (pap) smear, strep throat, and the very early onset of flus and colds. It is exceptionally useful in two other conditions as an additive to antibiotic powders and ointments for external application to burns, wounds, and skin infections and as a wash for poisonous stings and bites. 

First aid for bites and scratches from animals should include cleaning the wound with soap and uncontaminated water, applying a antibiotic cream, then covering it. 

Cellulitis is an inflammation of the connective tissue underlying the penile skin that can he caused hy normal skin flora or hy exogenous bacteria, and often occurs where the skin has previously been broken cracks in the skin, cuts, burns, insect bites and surgical wounds. The mainstay of therapy is treatment with appropriate antibiotics. 

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