“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #97

Puppy Dog German Shepherd Ridgeback  - DaModernDaVinci / Pixabay

Have a patient who has sustained a dog, cat, or even human bite? Are you wanting to put them on prophylactic antibiotics to prevent serious infection? Then know what antibiotics to put your patients on!

It absolutely astonishes me sometimes the antibiotics I see providers (MDs, DOs, PAs, and NPs) prescribe to patients who sustain a human or cat/dog bite… there are multiple pathogens such as Eikenella Corrodens and Pasteurella Multocida that first generation cephalosporins (cephalexin), macrolides, many penicillins, and clindamycin don’t cover.  

When a patient presents with a human, dog, or cat bite, the first line treatment option for prophylactic treatment and treatment of active infections in the outpatient setting is Augmentin 875/125mg twice daily. If the patient is allergic to penicillin, then another reasonable option is Doxycycline 100mg twice daily AND Metronidazole 500mg TID or Clindamycin 300mg TID. Always make sure to update their tetanus as well!

Remember this the next time you see a patient with a human or dog/cat bite and prescribe them an appropriate antibiotic! Don’t be one of those providers that makes me shake my head when the patient presents with a worsening infection because they were prescribed cephalexin for a dog bite…

As always, use your best clinical judgement!

4 Responses

  1. Exactly…you never know what was in that mouth or where it has been. Another example is a puncture wound. We never know what, at one time, was on a rusty nail that was sticking out of the ground…maybe animal feces…then our diabetic patient with poor circulation steps on it but doesn’t know it.
    Good read! Thanks for going back to the basics.

    1. Good points! You never know.

      Sometimes some basic clinical knowledge is a good reminder for folks out there. Thanks for the comment!

  2. I could not agree more. ALSO… patients often want to downplay cat & dog bites. Just because Fido or Felix “has his shots” doesn’t mean their mouth is clean and your bite won’t get infected. Two different issues. Yay, you won’t get rabies, BUT the wound may still get infected. Yes, I’m sure you need to take these antibiotics even though your cat is an “indoor cat.”

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