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).
Antibiotics
Class Summary
Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.
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.
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.
Toxoids
Class Summary
These agents are used to induce active immunity against tetanus in selected patients.
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.
Vaccines
Class Summary
In the event of possible rabies exposure, human diploid vaccine can be administered.
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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The child in this photo sustained a dog bite to the face. Courtesy of Wikimedia Commons, Tanner Ford, TRFPhotography.
