eMedicine Specialties > Infectious Diseases > Bacterial Infections
Pasteurella Multocida Infection: Treatment & Medication
Updated: Jan 21, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Because P multocida infection is mostly encountered in the setting of an injury following an animal bite, physicians must be familiar with the associated microbiological oral flora of certain animals, especially dogs and cats.
- Most animal bites are polymicrobial, with both aerobic and anaerobic bacteria. Several species can be isolated at once.
- Several Pasteurella species are associated with dog and cat bites, including P multocida subspecies multocida, P multocida subspecies septica, Pasteurella stomatis, and Pasteurella dogmatis. Pasteurella canis is associated only with dog bites.
- Other fastidious gram-negative organisms that have been associated with dog and cat bites include Capnocytophaga canimorsus and Capnocytophaga cynodegmi, especially in patients who had undergone previous splenectomy. C canimorsus infection can cause fulminant sepsis and meningitis, whereas C cynodegmi infection usually causes a milder localized inflammation.
- Several other organisms are associated with cat bites, including Bartonella henselae , Francisella tularensis, and cowpox virus.
- Medical management of animal bite wounds includes local wound care, standard-protocol tetanus prophylaxis, standard-protocol rabies prophylaxis, and either oral or intravenous empiric antimicrobial treatment.
- Antimicrobial treatment is discussed in Medication.
- Local care of bite wounds includes cleansing and removing nonviable tissue.
- Gently cleanse the skin surrounding the bite wound with an antiseptic solution. To prevent further tissue injury, do not scrub the wound directly.
- Soaking is of no benefit, but copious irrigation with a small-gauge catheter on a syringe helps remove debris and decreases the concentration of bacteria in contaminated wounds. Debridement and closure are discussed in Surgical Care.
Surgical Care
The initial assessment of an animal bite includes an estimation of the infection risk. Bites to the head and neck, to the distal extremities, and near joints carry the highest risk of infection. In general, persons with animals bite wounds are at a high risk for infection, especially those who present to medical attention more than 8-10 hours after the injury occurred.
Persons with underlying medical diseases, such as diabetes mellitus, chronic liver disease, asplenia, alcoholism, HIV infection, or other immunodeficiency conditions (including chronic steroid exposure), are at increased risk of infection.
- After irrigation and cleansing, sharply débride nonviable tissue to reduce the risk of infection and to allow easier suturing by providing a more even edge.
- Primary suturing of bite wounds is reserved for minor injuries, those at low risk for infection, and those that have been treated within 8-10 hours of injury.
- Leave all other wounds open until the risk of infection is reduced by cleansing, debridement, and prophylactic antibiotics.
Consultations
- General surgeon
- Orthopedic surgeon
Activity
- Elevation is of great importance in the management of limb injuries. Lack of elevation may result in excessive edema, which may produce compartment syndrome and compromise local circulation, to the extent of threatening the viability of the limb.
- Wounds on extremities should be immobilized and elevated with a sling to reduce edema, which may hamper normal activities.
Medication
Antimicrobial resistance among Pasteurella isolates is rarely reported in humans. Tetracyclines, erythromycin, and penicillin are most commonly associated with resistance. Penicillin-resistant strains have been isolated only from respiratory tract infections. Most animal-bite injuries can be treated with oral antimicrobials on an outpatient basis. Severe or partially responding infections may necessitate hospitalization and parenteral antimicrobial administration, along with surgical intervention.
Most Pasteurella isolates are susceptible to oral antimicrobials such as amoxicillin, amoxicillin/clavulanic acid, minocycline, fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin), and trimethoprim-sulfamethoxazole. Based on in vitro susceptibility data, several antimicrobials should not be used empirically for P multocida infections, including dicloxacillin, vancomycin, cephalexin, cefaclor, cefadroxil, erythromycin, and clindamycin. Macrolide resistance is usually encountered with erythromycin. Other macrolides, including azithromycin, clarithromycin, and telithromycin (in order of decreasing susceptibility), retain in vitro activity against most Pasteurella strains. Aminoglycosides have poor activity against P multocida.
More-severe infections may require parenteral antibiotics. Intravenous ampicillin-sulbactam, ticarcillin-clavulanate, piperacillin-tazobactam, cefoxitin, and carbapenems (imipenem-cilastatin, meropenem, ertapenem) are excellent empiric options for animal-bite injuries, providing gram-positive, gram-negative, and anaerobic coverage. The new tetracycline-derivative tigecycline also has excellent in vitro activity against P multocida and other pathogens encountered in animal and bite injuries. If P multocida is the only isolated organism, therapy may be changed to intravenous penicillin G. Once clinical improvement is noted, oral penicillin VK is an option. Patients with penicillin allergies can receive minocycline, doxycycline, fluoroquinolones, trimethoprim-sulfamethoxazole, or azithromycin.
The duration of therapy for P multocida infections has not been well established and can be tailored to clinical response. Milder soft-tissue infections usually require 7-10 days of oral therapy. More-severe cases can be treated for 10-14 days. Deep-tissue infections often require 4-6 weeks of therapy, usually intravenously at first.
Antibiotics
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Amoxicillin and clavulanate (Augmentin)
Drug combination treats bacteria resistant to beta-lactam antibiotics. For children >3 mo, base dosing protocol on amoxicillin content. Because of different ratios of amoxicillin to clavulanic acid 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.
Adult
500-875 mg PO q12h or 250-500 mg PO q8h
Pediatric
<40 kg: 20-40 mg/kg/d PO divided bid
>40 kg: Administer as in adults
Coadministration with warfarin or heparin increases risk of bleeding
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment; may increase risk of candidiasis
Cefuroxime (Ceftin, Zinacef)
Second-generation cephalosporin that maintains gram-positive activity of first-generation cephalosporins; adds activity against Proteus mirabilis, H influenzae, Escherichia coli, Klebsiella pneumoniae, and Moraxella catarrhalis. Condition of patient, severity of infection, and susceptibility of microorganism determine proper dose and route of administration.
Adult
500 mg PO bid; alternatively, 750-1500 mg IV/IM q8h; not to exceed 6 g/d
Pediatric
Children: 250 mg PO bid
Adolescents: Administer as in adults
Disulfiramlike reactions may occur when alcohol is consumed within 72 h after administration; may increase hypoprothrombinemic effects of anticoagulants; may increase nephrotoxicity in patients receiving potent diuretics (eg, loop diuretics); coadministration with aminoglycosides increase nephrotoxic potential
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Reduce dosage by half if CrCl is 10-30 mL/min and by three quarters if <10 mL/min (high doses may cause CNS toxicity); bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy
Doxycycline (Vibra-Tabs, Bio-Tab, Doryx, Vibramycin)
Inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.
Adult
200 mg PO/IV immediately, followed by 100-200 mg PO q12h
Pediatric
<8 years: Not recommended
>8 years: 2-5 mg/kg/d PO/IV qd or divided bid; not to exceed 200 mg/d
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy
Documented hypersensitivity; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last half of pregnancy through 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
Penicillin G (Pfizerpen)
Inhibits biosynthesis of cell wall mucopeptide. Bactericidal against sensitive organisms when adequate concentrations are reached. Most effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects. Use penicillin VK for PO or penicillin G for IV.
Adult
Penicillin VK 250-500 mg PO q6h or penicillin G sodium aqueous 2-4 million U IV q4h (not to exceed 24 million U/d)
Pediatric
50,000 U/kg IM; not to exceed 2.4 million U
Probenecid may increase effectiveness by decreasing clearance; tetracyclines are bacteriostatic, causing a decrease in the effectiveness of penicillins when administered concurrently
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in renal impairment
Ampicillin and sulbactam (Unasyn)
Drug combination of beta-lactamase inhibitor with ampicillin. Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.
Adult
1.5 (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) IV/IM q6h; not to exceed 4 g/d sulbactam or 8 g/d ampicillin
Pediatric
3 months to 12 years: 100-200 mg ampicillin/kg/d (150-300 mg Unasyn) IV divided q6h
>12 years: Administer as in adults; not to exceed 4 g/d sulbactam or 8 g/d ampicillin
Probenecid and disulfiram elevate ampicillin levels; allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction
Ticarcillin and clavulanate (Timentin)
Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active growth. Antipseudomonal penicillin plus beta-lactamase inhibitor that provides coverage against most gram-positive organisms, most gram-negative organisms, and most anaerobes.
Adult
3.1 g (3 g ticarcillin and 0.1 g clavulanate) IV q6h
Pediatric
75 mg/kg IV q6h
Tetracyclines may decrease effects of ticarcillin; high concentrations of ticarcillin may physically inactivate aminoglycosides if administered in same IV line; effects are synergistic when administered concurrently with aminoglycosides; probenecid may increase penicillin levels
Documented hypersensitivity; severe pneumonia, bacteremia, pericarditis, emphysema, meningitis, and purulent or septic arthritis should not be treated with oral penicillin during acute stage
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Perform CBC count prior to initiation of therapy and at least weekly during therapy; monitor for liver function abnormalities by measuring AST and ALT during therapy; exercise caution in patients with hepatic insufficiencies; perform urinalysis and BUN and creatinine determinations during therapy and adjust dose if values become elevated; monitor blood levels to avoid possible neurotoxic reactions
Ciprofloxacin (Cipro)
Mode of action of all quinolones involves inhibition of bacterial DNA synthesis by blocking the enzyme DNA gyrase
Adult
250-500 mg PO bid
Pediatric
<18 years: Not recommended
>18 years: Administer as in adults
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; reduces therapeutic effects of phenytoin; probenecid may increase serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy
Amoxicillin (Trimox, Amoxil)
Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria.
Adult
1 g PO q8h; not to exceed 3 g/d
Pediatric
20-50 mg/kg/d PO divided q8h; not to exceed 2 g/dose
Reduces efficacy of oral contraceptives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment; may increase risk of candidiasis
Levofloxacin (Levaquin)
For pseudomonal infections and infections due to multidrug-resistant gram-negative organisms.
Adult
500-750 mg PO qd
Pediatric
<18 years: Not recommended
>18 years: Administer as in adults
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; reduces therapeutic effects of phenytoin; probenecid may increase serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy
Ampicillin (Principen, Omnipen)
Bactericidal activity against susceptible organisms. Alternative to amoxicillin when unable to take medication PO.
Adult
250-500 mg PO q6h
2 g IV/IM q4h
Not to exceed 12 g/d
Pediatric
50-100 mg/kg/d PO divided q4-6h
100-400 mg/kg/d IV/IM divided q4-6h
Probenecid and disulfiram elevate levels; allopurinol decreases effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction
Piperacillin and tazobactam sodium (Zosyn)
Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active multiplication.
Adult
3/0.375 g (piperacillin 3 g and tazobactam 0.375 g) IV q6h
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Tetracyclines may decrease effects of piperacillin; high concentrations of piperacillin may physically inactivate aminoglycosides if administered in same IV line; effects when administered concurrently with aminoglycosides are synergistic; probenecid may increase penicillin levels; high-dose parenteral penicillins may result in increased bleeding risk
Documented hypersensitivity; severe pneumonia, bacteremia, pericarditis, emphysema, meningitis and purulent or septic arthritis should not be treated with an oral penicillin during the acute stage
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Perform CBC counts prior to initiation of therapy and at least weekly during therapy; monitor for liver function abnormalities by measuring AST and ALT during therapy; exercise caution in patients diagnosed with hepatic insufficiencies; perform urinalysis and BUN and creatinine determinations during therapy and adjust dose if values become elevated; monitor blood levels to avoid possible neurotoxic reactions
Ertapenem (Invanz)
Bactericidal activity results from inhibition of cell wall synthesis and is mediated through ertapenem binding to penicillin-binding proteins. Stable against hydrolysis by various beta-lactamases including penicillinases, cephalosporinases, and extended-spectrum beta-lactamases. Hydrolyzed by metallo-beta-lactamases.
Adult
1 g qd for 14 d if IV and 7 d if IM; infuse over 30 min if IV
CrCl <30 mL/min/1.73 m2: 500 mg IV qd
Pediatric
<3 months: Not established
3 months to 12 years: 15 mg/kg IV q12h; not to exceed 1 g/d
>12 years: Administer as in adults
Probenecid may reduce renal clearance of ertapenem and increase half-life but benefit is minimum and does not justify coadministration
Documented hypersensitivity to drug or amide type anesthetics
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Pseudomembranous colitis may occur; seizures and CNS adverse reactions may occur; when using with lidocaine to administer intramuscularly, avoid inadvertent injection into blood vessel; decrease dose in renal failure; serious and occasionally fatal hypersensitivity reactions may occur with beta lactams, caution with previous hypersensitivity reactions to penicillin, cephalosporins, other beta lactams, or other allergens; do not mix or coinfuse in same IV line as other medications; do not mix with dextrose-containing diluents
Imipenem and cilastatin (Primaxin)
For treatment of multi-organism infections in which other agents do not have wide-spectrum coverage or are contraindicated because of potential for toxicity.
Adult
Base initial dose on severity of infection and administer in equally divided doses; dose may range from 250-500 mg q6h IV for a maximum of 3-4 g/d
Alternatively, 500-750 mg q12h IM or intra-abdominally
Pediatric
Infants >3 months and children <12 years: 15-25 mg/kg/dose IV q6h
Fully susceptible organisms: not to exceed 2 g/d
Infections with moderately susceptible organisms: not to exceed 4 g/d
>12 years: Administer as in adults
Coadministration with cyclosporine may increase CNS side effects of both agents; coadministration with ganciclovir may result in generalized seizures
Documented hypersensitivity; known hypersensitivity to amide local anesthetics; children with CNS infections (increased seizure risk); children <30 kg with renal impairment (lack of data)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adjust dose in renal insufficiency (adult adjustments)
CrCl (mL/min) 80-50: 0.5 g q6-8h
CrCl 50-10: 0.5 g q8-12h
Hemodialysis (HD): 0.25-0.5 g after HD, then q12h
Adjust dose in renal insufficiency; avoid use in children <12 y with CNS infections
Caution with history of seizures, hypersensitivity to penicillins, cephalosporins, or other beta-lactam antibiotics
Minocycline (Dynacin, Minocin)
Treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma species.
Adult
100 mg PO bid
Pediatric
<8 years: Not recommended
>8 years: 4 mg/kg PO initially, followed with 2 mg/kg q12h
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; tetracyclines can increase hypoprothrombinemic effects of anticoagulants
Documented hypersensitivity; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one-half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines; hepatitis or lupuslike syndromes may occur
Cefoxitin (Mefoxin)
Second-generation cephalosporin with activity against some gram-positive cocci, gram-negative rod infections, and anaerobic bacteria. Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins; inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell wall death.
Infections caused by cephalosporin- or penicillin-resistant gram-negative bacteria may respond to cefoxitin.
Adult
1-2 g IV/IM q6-8h or 1-2 g IV/IM q4h in severe cases
Pediatric
Infants and children: 80-160 mg/kg/d IV divided q4-6h; higher doses for severe or serious infections; not to exceed 12 g/d
Probenecid may increase effects of cefoxitin; coadministration with aminoglycosides or furosemide may increase nephrotoxicity (closely monitor renal function)
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy
Sulfamethoxazole and trimethoprim (Bactrim, Bactrim DS, Septra, Septra DS)
Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.
Antibacterial activity of TMP-SMZ includes common urinary tract pathogens, except Pseudomonas aeruginosa.
Adult
160 mg TMP/800 mg SMZ (1 tab DS) PO q12h for 10-14 d
Pediatric
<2 months: Do not administer
>2 months: 10-20 mg TMP/kg/d PO/IV divided tid/qid for 14 d
May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly patients; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine
Documented hypersensitivity; megaloblastic anemia due to folate deficiency; age <2 mo
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Do not use during last trimester of pregnancy because of potential toxicity to newborn (eg, jaundice, hemolytic anemia, kernicterus)
Dosage adjustments (adult adjustments)
CrCl (mL/min) 80-50: Recommended IV dose q18h
CrCl 50-10: Recommended IV dose q24h
CrCl <10: Not recommended
HD: 4-5 mg/kg after HD
During peritoneal dialysis: 0.16-0.8 g q48h
Discontinue at first appearance of skin rash or sign of adverse reaction; obtain CBC counts frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in folate deficiency (eg, chronic alcoholics, elderly, those receiving anticonvulsant therapy, or those with malabsorption syndrome); hemolysis may occur in G-6-PD deficient individuals; AIDS patients may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); give fluids to prevent crystalluria and stone formation
Azithromycin (Zithromax)
Acts by binding to 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected.
Concentrates in phagocytes and fibroblasts as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues.
Treats mild-to-moderate microbial infections.
Adult
500 mg PO qd
Pediatric
<6 months: Not established
>6 months:
Day 1: 10 mg/kg PO once; not to exceed 500 mg/d
Days 2-5: 5 mg/kg PO qd; not to exceed 250 mg/d
May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine
Documented hypersensitivity; hepatic impairment; do not administer with pimozide
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Site reactions can occur with IV route; bacterial or fungal overgrowth may result from prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function or prolonged QT intervals
Tigecycline (Tygacil)
A glycylcycline antibiotic that is structurally similar to tetracycline antibiotics. Inhibits bacterial protein translation by binding to 30S ribosomal subunit and blocks entry of amino-acyl tRNA molecules in ribosome A site. Complicated intra-abdominal infections caused by C freundii, E cloacae, E coli, K oxytoca, K pneumoniae, E faecalis (vancomycin-susceptible isolates only), S aureus (methicillin-susceptible isolates only), S anginosus group (includes S anginosus, S intermedius, and S constellatus), B fragilis, B thetaiotaomicron, B uniformis, B vulgatus, C perfringens, and P micros.
Adult
Infuse each dose over 30-60 min
100 mg IV once, then 50 mg IV q12h
Severe hepatic impairment (ie, Child Pugh class C): 100 mg IV once, then 25 mg IV q12h
Pediatric
<18 years: Not established
>18 years: Administer as in adults
Coadministration decreases warfarin clearance and increases warfarin Cmax and AUC (monitor aPTT and INR); coadministration of antibiotics with oral contraceptives may decrease contraceptive effect
Documented hypersensitivity
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in severe hepatic impairment (reduce dose); may adversely effect tooth development; may permit clostridia overgrowth, resulting in antibiotic-associated colitis; may have adverse effects similar to tetracyclines (eg, photosensitivity, pseudotumor cerebri, pancreatitis, antianabolic action)
More on Pasteurella Multocida Infection |
| Overview: Pasteurella Multocida Infection |
| Differential Diagnoses & Workup: Pasteurella Multocida Infection |
 Treatment & Medication: Pasteurella Multocida Infection |
| Follow-up: Pasteurella Multocida Infection |
| Multimedia: Pasteurella Multocida Infection |
| References |
| « Previous Page | Next Page » |
References
Dryden MS, Dalgliesh D. Pasteurella multocida from a dog causing Ludwig's angina. Lancet. Jan 13 1996;347(8994):123. [Medline].
Lion C, Lozniewski A, Rosner V, et al. Lung abscess due to beta-lactamase-producing Pasteurella multocida. Clin Infect Dis. Nov 1999;29(5):1345-6. [Medline].
Fernandez-Esparrach G, Mascaro J, Rota R, et al. Septicemia, peritonitis, and empyema due to Pasteurella multocida in a cirrhotic patient. Clin Infect Dis. Mar 1994;18(3):486. [Medline].
Nettles RE, Sexton DJ. Pasteurella multocida prosthetic valve endocarditis: case report and review. Clin Infect Dis. Oct 1997;25(4):920-1. [Medline].
Wade T, Booy R, Teare EL, et al. Pasteurella multocida meningitis in infancy - (a lick may be as bad as a bite). Eur J Pediatr. Nov 1999;158(11):875-8. [Medline].
Tattevin P, Souala F, Gautier AL, et al. Diabetes in patients with pasteurellosis. Scand J Infect Dis. 2005;37(10):731-3. [Medline].
Rollof J, Johansson PJ, Holst E. Severe Pasteurella multocida infections in pregnant women. Scand J Infect Dis. 1992;24(4):453-6. [Medline].
Waldor M, Roberts D, Kazanjian P. In utero infection due to Pasteurella multocida in the first trimester of pregnancy: case report and review. Clin Infect Dis. Feb 1992;14(2):497-500. [Medline].
American Academy of Pediatrics. Bite Wounds. In: Red Book 2000 - Report of the Committee on Infectious Diseases. 25th ed. Oak Grove, Ill: American Academy of Pediatrics; 2000:156-9.
Brivet F, Guibert M, Barthelemy P, et al. Pasteurella multocida sepsis after hemorrhagic shock in a cirrhotic patient: possible role of endoscopic procedures and gastrointestinal translocation. Clin Infect Dis. May 1994;18(5):842-3. [Medline].
Champlin FR, Shryock TR, Patterson CE, et al. Prevalence of a novel capsule-associated lipoprotein among pasteurellaceae pathogenic in animals. Curr Microbiol. Apr 2002;44(4):297-301. [Medline].
Chang K, Siu LK, Chen YH, et al. Fatal Pasteurella multocida septicemia and necrotizing fasciitis related with wound licked by a domestic dog. Scand J Infect Dis. 2007;39(2):167-70. [Medline].
Citron DM, Warren YA, Fernandez HT, et al. Broth microdilution and disk diffusion tests for susceptibility testing of Pasteurella species isolated from human clinical specimens. J Clin Microbiol. May 2005;43(5):2485-8. [Medline].
Clark RB, Joyce SE. Activity of meropenem and other antimicrobial agents against uncommon gram-negative organisms. J Antimicrob Chemother. Aug 1993;32(2):233-7. [Medline].
Fajfar-Whetstone CJ, Coleman L, Biggs DR, Fox BC. Pasteurella multocida septicemia and subsequent Pasteurella dagmatis septicemia in a diabetic patient. J Clin Microbiol. Jan 1995;33(1):202-4. [Medline].
Goldstein EJ, Citron DM. Comparative activities of cefuroxime, amoxicillin-clavulanic acid, ciprofloxacin, enoxacin, and ofloxacin against aerobic and anaerobic bacteria isolated from bite wounds. Antimicrob Agents Chemother. Aug 1988;32(8):1143-8. [Medline].
Goldstein EJ, Citron DM, Merriam CV, et al. Activity of gatifloxacin compared to those of five other quinolones versus aerobic and anaerobic isolates from skin and soft tissue samples of human and animal bite wound infections. Antimicrob Agents Chemother. Jun 1999;43(6):1475-9. [Medline].
Goldstein EJ, Citron DM, Merriam CV, et al. Comparative in vitro activities of GAR-936 against aerobic and anaerobic animal and human bite wound pathogens. Antimicrob Agents Chemother. Oct 2000;44(10):2747-51. [Medline].
Goldstein EJ, Citron DM, Richwald GA. Lack of in vitro efficacy of oral forms of certain cephalosporins, erythromycin, and oxacillin against Pasteurella multocida. Antimicrob Agents Chemother. Feb 1988;32(2):213-5. [Medline].
Green BT, Ramsey KM, Nolan PE. Pasteurella multocida meningitis: case report and review of the last 11 y. Scand J Infect Dis. 2002;34(3):213-7. [Medline].
Griego RD, Rosen T, Orengo IF, et al. Dog, cat, and human bites: a review. J Am Acad Dermatol. Dec 1995;33(6):1019-29. [Medline].
Kimura R, Hayashi Y, Takeuchi T, et al. Pasteurella multocida septicemia caused by close contact with a domestic cat: case report and literature review. J Infect Chemother. Aug 2004;10(4):250-2. [Medline].
Koch CA, Mabee CL, Robyn JA, et al. Exposure to domestic cats: risk factor for Pasteurella multocida peritonitis in liver cirrhosis?. Am J Gastroenterol. Jul 1996;91(7):1447-9. [Medline].
Kravetz JD, Federman DG. Cat-associated zoonoses. Arch Intern Med. Sep 23 2002;162(17):1945-52. [Medline].
Layton CT. Pasteurella multocida meningitis and septic arthritis secondary to a cat bite. J Emerg Med. May-Jun 1999;17(3):445-8. [Medline].
Lion C, Conroy MC, Carpentier AM, et al. Antimicrobial susceptibilities of Pasteurella strains isolated from humans. Int J Antimicrob Agents. Apr 2006;27(4):290-3. [Medline].
Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, Pa: Churchill Livingstone; 2000:2404-7.
Meha H, Mackle I. Prosthetic joint infection with Pasteurella multocida following cat scratch: a report of 2 cases. J Arthroplasty. Jun 2004;19(4):525-7.
Murphy E. Microbiology of animal bites. Clinical Microbiology Newsletter. Apr 2008;30(7):47-50.
Rosenau A, Labigne A, Escande F, et al. Plasmid-mediated ROB-1 beta-lactamase in Pasteurella multocida from a human specimen. Antimicrob Agents Chemother. Nov 1991;35(11):2419-22. [Medline].
Ruiz-Irastorza G, Garea C, Alonso JJ, et al. Septic shock due to Pasteurella multocida subspecies multocida in a previously healthy woman. Clin Infect Dis. Jul 1995;21(1):232-4. [Medline].
Spagnuolo PJ. Pasteurella multocida infectious arthritis. Am J Med Sci. May-Jun 1978;275(3):359-63. [Medline].
Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. Nov 15 2005;41(10):1373-406. [Medline].
Weber DJ, Wolfson JS, Swartz MN, et al. Pasteurella multocida infections. Report of 34 cases and review of the literature. Medicine (Baltimore). May 1984;63(3):133-54. [Medline].
Further Reading
Keywords
Pasteurella multocida infection, P multocida infection, pasteurellosis, coccobacillus, coccobacilli, bacterial infection, dog bite, cat bite, cat scratch, bite wound, animal bite wound, cat lick, pet wound, pet bite, meningitis, tetanus, rabies
