Human Bites in Emergency Medicine Medication
- Author: Jeffrey Barrett, MD; Chief Editor: Rick Kulkarni, MD more...
Medication Summary
The only drug therapy of significance in human bites is antibiotic treatment. Bacterial flora include that of the mouth and skin. Theoretically, penicillin treats oral pathogens and may suffice for prophylactic treatment as Staphylococcus species probably only infect bite wounds secondarily.
Once a human bite is infected, beta-lactamase–producing staphylococci must be addressed. Eikenella corrodens may not be covered by first-generation cephalosporins. Additionally, Eikenella species are resistant to clindamycin, penicillinase-resistant semisynthetic penicillins, and metronidazole. A broad-spectrum antibiotic, rather than combination therapy, is the usual choice for infected bite wounds. An in vitro study of 50 infected human bites by Talan et al indicated that amoxicillin-clavulanic acid and moxifloxacin demonstrated excellent activity against common isolates.[8]
Antibiotics
Class Summary
Therapy must cover all likely pathogens in the context of the clinical setting.
Amoxicillin/clavulanate (Augmentin)
Drug combination that extends antibiotic spectrum of this penicillin to include bacteria normally resistant to beta-lactam antibiotics. DOC for noninfected human bite wounds. Dosing is based on amoxicillin component. Indicated for skin and skin structure infections caused by beta-lactamase-producing strains of Staphylococcus aureus.
Ampicillin/sulbactam sodium (Unasyn)
Drug combination that uses beta-lactamase inhibitor with ampicillin; covers skin, enteric flora, and anaerobes. DOC for infected bites.
Cefoxitin (Mefoxin)
Alternative drug for infected bites; second-generation cephalosporin indicated for management of infections caused by susceptible gram-positive cocci and gram-negative rods. Many infections that are caused by gram-negative bacteria and are resistant to some cephalosporins and penicillins respond to cefoxitin.
Moxifloxacin (Avelox)
Inhibits the A subunits of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription.
Immunizing agents
Class Summary
These agents are used to immunize patients against tetanus.
Tetanus immune globulin (TIG)
Used for passive immunization of any person with a wound that may be contaminated with tetanus spores.
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