Human Bites Medication

Updated: Aug 10, 2018
  • Author: Jeffrey Barrett, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Medication

Medication Summary

Empiric antibiotic therapy needs to be aimed at E corrodens, a wide variety of beta-lactamase–producing anaerobes, and S aureus.

There are no set guidelines to cover empirically for MRSA. However, if an abscess or gross purulence is present, treatment for MRSA should be initiated pending final culture results. Eikenella corrodens may not be covered by first-generation cephalosporins. These isolates are also resistant to clindamycin, penicillinase-resistant semisynthetic penicillins, macrolides, and aminoglycosides.

In an in vitro study of 50 infected human bites, Talan et al found that amoxicillin-clavulanic acid and moxifloxacin demonstrated excellent activity against the most common isolates. [26] The combination of a penicillinase-resistant penicillin with a second- or third-generation cephalosporin and metronidazole would provide an alternative.

Strong consideration should be given to admitting patients with human bite infections, especially those with bites to the hands or cartilage. [27]

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Antibiotics, Other

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, Augmentin XR, Amoclan)

This drug combination treats bacteria that are resistant to beta-lactam antibiotics. It is the most effective and economical choice for outpatient therapy, unless contraindicated. In children over age 3 months, base the dosing protocol on amoxicillin content.

Because of different amoxicillin/clavulanic acid ratios in the 250-mg tablet (250/125) versus the 250-mg chewable tablet (250/62.5), do not use the 250-mg tablet until the child weighs more than 40 kg.

Doxycycline (Doryx, Vibramycin, Adoxa)

Doxycycline is an alternative for oral therapy in the penicillin-allergic patient. It inhibits protein synthesis and, therefore, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Doxycycline is a broad-spectrum, synthetically derived bacteriostatic tetracycline antibiotic. It is almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations.

Cefoxitin sodium (Mefoxin)

This is an alternative drug for infected bites Cefoxitin is a 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.

Cefoxitin inhibits bacterial cell-wall synthesis by binding to 1 or more penicillin-binding proteins. It inhibits the final transpeptidation step of peptidoglycan synthesis, resulting in cell-wall death.

Ampicillin sodium and sulbactam (Unasyn)

This drug combination, of a beta-lactamase inhibitor and ampicillin, covers skin, enteric flora, and anaerobes. It is not ideal for nosocomial pathogens.

The medication interferes with bacterial cell-wall synthesis during active replication, resulting in bactericidal activity against susceptible organisms. It can be administered as an alternative to amoxicillin in patients who are unable to take oral medication.

Ticarcillin disodium and clavulanic acid (Timentin)

This drug combination inhibits biosynthesis of cell wall mucopeptide and is effective during the stage of active growth.

Moxifloxacin (Avelox)

Moxifloxacin inhibits the A subunits of deoxyribonucleic acid (DNA) gyrase, resulting in inhibition of bacterial DNA replication and transcription.

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Immunizing Agents

Class Summary

These agents are used to passively immunize patients against tetanus.

Tetanus immunoglobulin (HyperTET S/D)

This is used for passive immunization of any person with a wound that may be contaminated with tetanus spores.

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