Human Bites Medication

  • Author: Ian K McLeod, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Dec 2, 2011
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Antibiotics

Class Summary

Several antibiotics are commonly used in cases of human bite wounds.

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Amoxicillin and clavulanic acid (Augmentin)

 

Most effective and economical choice for outpatient therapy unless contraindicated.

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Doxycycline (Doryx, Vibramycin, Vibra-Tabs)

 

Broad-spectrum, synthetically derived bacteriostatic tetracycline antibiotic. Almost completely absorbed, concentrates in bile, and excreted in urine and feces as a biologically active metabolite in high concentrations. Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. May block dissociation of peptidyl t-RNA from ribosomes, arresting RNA-dependent protein synthesis. Alternative oral therapy in patients with penicillin allergy.

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Ceftriaxone sodium (Rocephin)

 

Third-generation cephalosporin with broad-spectrum, gram-negative activity; low efficacy against gram-positive organisms, high efficacy against resistant organisms. Inhibits bacterial cell-wall synthesis by binding 1 or more penicillin-binding proteins. Antimicrobial effect by interfering with synthesis of peptidoglycan (major structural component of bacterial cell wall). Bacteria lyse because of ongoing activity of cell-wall autolytic enzymes while cell-wall assembly arrested. Highly stable in presence of beta-lactamases (penicillinase, cephalosporinase) of gram- and gram-positive bacteria.

About 33-67% of dose excreted unchanged in urine; rest secreted in bile and ultimately in feces as microbiologically inactive compounds. Reversibly binds to human plasma proteins; binding reported to decrease from 95% bound at plasma concentration < 25 mcg/mL to 85% bound at 300 mcg/mL.

Noncompliant patients may benefit from once-daily IM dosing; also may be used as IV antibiotic in inpatients.

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Cefoxitin (Mefoxin)

 

Second-generation cephalosporin with activity against some gram-positive cocci, gram-negative rods, and anaerobic bacteria. Inhibits bacterial cell-wall synthesis by binding to 1 or more 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.

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Ampicillin sodium and sulbactam (Unasyn)

 

Drug combination of beta-lactamase inhibitor with ampicillin. Interferes with bacterial cell-wall synthesis during active replication, resulting in bactericidal activity against susceptible organisms. Alternative to amoxicillin in patients unable to take oral medication.

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Ticarcillin disodium and clavulanic acid (Timentin)

 

Inhibits biosynthesis of cell-wall mucopeptide and effective during stage of active growth.

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Contributor Information and Disclosures
Author

Ian K McLeod, MD  Assistant Professor, Department of Surgery, Uniformed Services University of the Health Sciences; Chief, Otolaryngology Service, DeWitt Army Community Hospital

Ian K McLeod, 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.

Coauthor(s)

Daniel J Gallagher III, MD  Attending Surgeon, Department of Otolaryngology, Walter Reed and DeWitt Army Hospitals

Daniel J Gallagher III, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Medical Association

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

David W Stepnick, MD  Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center

David W Stepnick, 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, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons

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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