What are the goals of initial antibiotic therapy for animal bites?

Updated: Sep 18, 2018
  • Author: Alisha Perkins Garth, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

The goal of initial therapy is to cover staphylococci, streptococci, anaerobes, and Pasteurella species. Prophylactic antibiotics may be given for a 3- to 5-day course. If the wound is infected on presentation, a course of 10 days or longer is recommended.

The first-line oral therapy is amoxicillin-clavulanate. For higher-risk infections, a first dose of antibiotic may be given intravenously (ie, ampicillin-sulbactam, ticarcillin-clavulanate, piperacillin-tazobactam, or a carbapenem). Other combinations of oral therapy include cefuroxime plus clindamycin or metronidazole, a fluoroquinolone plus clindamycin or metronidazole, sulfamethoxazole and trimethoprim plus clindamycin or metronidazole, penicillin plus clindamycin or metronidazole, and amoxicillin plus clindamycin or metronidazole; a less effective alternative is azithromycin or doxycycline plus clindamycin or metronidazole. [9, 10, 28]

Primate bites, particularly from macaque monkeys, pose a risk of herpes virus B infection. [7] For macaque bites, postexposure prophylaxis with valacyclovir or acyclovir should be given for 14 days after immediate and thorough wound disinfection. [29]


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