Animal Bites Medication

  • Author: Suzanne K Doud Galli, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Sep 23, 2011
 

Medication Summary

Injuries to the head and neck region have a lower risk of infection than injuries to the extremities. The risk of infection is increased with puncture wounds, treatment delay (6-12 h), and in patients older than 50 years. Likewise, patients who are immunocompromised are at increased risk.

The most common organisms are Staphylococcus species, Streptococcus species, Pasteurella multocida, and anaerobic organisms. No single drug of choice exists for empiric therapy (ie, no single drug targets all these organisms).

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Antibiotics

Class Summary

Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.

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Amoxicillin and clavulanate (Augmentin)

 

Drug combination treats bacteria resistant to beta-lactam antibiotics.

In children >3 mo, base dosing protocol on amoxicillin content. Due to 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.

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Penicillin (Beepen-VK, Pfizerpen)

 

Inhibits biosynthesis of cell wall mucopeptide. Bactericidal against sensitive organisms when adequate concentrations are reached. Most effective during stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

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Toxoids

Class Summary

These agents are used to induce active immunity against tetanus in selected patients.

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Tetanus toxoid adsorbed or fluid

 

Immunizing agent of choice for most adults and children > 7 y is tetanus and diphtheria toxoids. Necessary to administer booster doses to maintain tetanus immunity throughout life. Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen–containing product.

In children and adults, may administer into deltoid or midlateral thigh muscles. In infants, preferred site of administration is the mid thigh laterally.

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Vaccines

Class Summary

In the event of possible rabies exposure, human diploid vaccine can be administered.

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Rabies virus vaccine (Imovax, RabAvert)

 

Inactivated form of virus grown in primary cultures of chicken fibroblasts. Offers active immunity and, when used in combination with human rabies immune globulin and local wound treatment, protects postexposure patients of all age groups. Fourteen days after initiating immunization series, antirabies antibody titers reach levels well above minimal protective level of 0.5 IU/mL.

Vaccine must be injected IM and never SC, ID, or IV. In adults, inject into deltoid muscle area. In small children, administer into anterolateral zone of thigh.

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Contributor Information and Disclosures
Author

Suzanne K Doud Galli, MD  PhD, FACS, Consulting Staff, Cosmetic Facial Surgery, Private Practice

Suzanne K Doud Galli, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society, and Triological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Philip J Miller, MD, FACS  Assistant Professor, Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, New York University School of Medicine

Philip J Miller, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American College of Surgeons, American Medical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Clark A Rosen, MD  Director, University of Pittsburgh Voice Center; Professor, Department of Otolaryngology and Communication Science and Disorders, University of Pittsburgh School of Medicine

Clark A Rosen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Pennsylvania Medical Society

Disclosure: Bioform Medical Consulting fee Consulting; Bioform Medical Consulting fee Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dominique Dorion, MD, MSc, FRCSC, FACS  Vice Dean and Associate Dean of Resources, Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Sherbrooke Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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