Human Bite Infections Medication
- Author: Don R Revis Jr, MD; Chief Editor: Burke A Cunha, MD more...
Medication Summary
The question of which patients require antibiotic therapy is a matter of considerable debate. Antibiotics cannot avert or cure infections in the face of poor wound care, reflecting the importance of meticulous treatment of the wound as the cornerstone of therapy. In regard to antibiotic therapy, it is best to err on the side of caution because the risks of antibiotic therapy are minimal, while the potential complications of bite wound infections are considerable.
In general, superficial noninfected wounds involving sites other than the hand that are evaluated early in the compliant patient without significant comorbidities may be treated without antibiotics if the wound is left open to heal by secondary intention.
Wounds of the hand, infected wounds, and wounds of the head and neck closed primarily mandate antibiotic therapy.
Wounds treated on an outpatient basis may be treated with oral antibiotics, whereas wounds requiring admission to the hospital should be treated with intravenous antibiotics.
Prophylaxis in the noninfected wound should be continued for 5-7 days, whereas therapeutic antibiotics should be administered for 10-14 days.
Selection of the appropriate antibiotic involves multiple factors, including culture results if obtained and available, drug sensitivities, patient age, drug interactions, expected compliance, and renal and hepatic function.
Antibiotics
Class Summary
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Amoxicillin and clavulanic acid (Augmentin)
Drug combination treats bacteria resistant to beta-lactam antibiotics. The most effective and economical choice for outpatient therapy unless contraindicated.
In children >3 mo, base dosing protocol on amoxicillin content. Because of different amoxicillin/clavulanic acid ratios in 250-mg tab (250/125) vs 250-mg chewable tab (250/62.5), do not use 250-mg tab until child weighs >40 kg.
Doxycycline (Doryx, Vibramycin, Vibra-Tabs)
Alternative for oral therapy in the penicillin-allergic patient. Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.
Ceftriaxone sodium (Rocephin)
Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins. Once-daily IM dosing may benefit the noncompliant patient. Also may be used as an IV antibiotic for patients admitted to the hospital.
Cefoxitin sodium (Mefoxin)
Second-generation cephalosporin indicated for gram-positive cocci and gram-negative rod infections. Infections caused by cephalosporin- or penicillin-resistant gram-negative bacteria may respond to cefoxitin.
Ampicillin sodium and sulbactam (Unasyn)
Drug combination of beta-lactamase inhibitor with ampicillin. Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.
Ticarcillin disodium and clavulanic acid (Timentin)
Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active growth.
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