Antimicrobial Therapy in Animal bite

st

Animal
Dog

Common microorganism
Pasteurella canis
Staphylococcus aureus
Bacteriodes sp.
Fusobacterium sp, EF-4
Capnocytophaga

1 Line Antibiotic
PO Augmentin 625mg BDTDS

Cat

Pasteurella multocida (75%)

Staphylococcus aureus

PO Augmentin 625mg BDTDS

Human

Viridans streptococcus (100%)

S.epidermidis (53%)
Corynebacterium sp (41%)
Staph. aureus (29%)
Eikenella sp. (15%)
Bacteriodes sp. (82%)
Peptostreptococcus sp. (26%)
Herpes simiae
(Herpes B virus)

Early (not yet infected)

Penicillin allergic
Augmentin 625mg BDClindamycin+
TDS
(Ciprofloxacin or
Later (Sign of infection,3- Bactrim)
4H)
IV Unasyn 1.5g Q6H
IV Tazosin 4.5g Q6-8H
Post-exposure prophylaxis
Valacyclovir 1g Q8H x14days or Acyclovir 800mg
5x/day x 14 days
Treatment
CNS Sx absent: IV Acyclovir 12.5-15mg/kg Q8H or
IV Ganciclovir 5mg/kg Q12H
CNS Sx present: IV Ganciclovir 5mg/kg Q12H
rd
PO Augmentin 625mg BD- IV 3 G Cephalosporin
TDS
IV Tazosin /Unasyn
/Imipenam
Prophylaxis
Prophylaxis: PO
PO Augmentin 625mg BD- Doxycycline 100mg
TDS x3 days
BD x3days
Rat bite fever
Rat bite fever:
IV Pen G 2MU Q4H or PO PO EES 400mg QID or
Doxycycline 100mg BD
Clindamycin 300mg
x10-14days
QID x 10-14days
PO Augmentin 625mg BD- PO Doxycycline
TDS
100mg BD
Ceftazadime + PCN +
Ceftriaxone +
metronidazole
doxycycline +
metronidazole

Monkey/
Primate

Pig/
Swine
Rat /
Rodent

Bat
Crocodile

Lizard/
iguana

Gram positive cocci

Gram negative bacilli
Anaerobes, Pasteurella sp.
Spirillum minus
Streptobacillus moniliformis

Streptococcus sp.
Staphylococcus sp. ,Rabies
Burkholderia pseudomallei,
Aeromonas, Proteus,
Pseudomonas ,Citrobacter sp
Clostridium, Bacteroides,
Fusobacterium, Peptococcus
Salmonella sp., Serratia
marcescens

Alternative
Adult:
PO Clindamycin
300mg QID +
Fluoroquinolone
Pediatric:
Clindamycin + Bactrim
PO Cefuroxime 500mg
Q12H or Doxycycline
100mg BD

Comment
Only 5% get infected. Upto 18% if hand
involved. Treat only if severe bite or patient
present bad co-morbidity, eg, diabetes.
P.canis R: Cloxa, Clinda, Cephalexin, Erythro
S: Ceftriaxone, Cefuroxime,Fluoroquinolone
80% get infected. Culture and treat
empirically
P.multocida infection developed within 24H.
Observe for osteomyelitis
If culture is + for only P.multocida, switch to
Pen VK PO.
P.multocida R to Cloxa, Cepha, Clinda.
Many strains resistant to Erythro
1015% of human bites becoming infected.
Eikenella sp (causes septic arthritis,
endocarditis)
S: fluoroquinolone, Bactrim
st
R:Clinda, Oxacillin, Metronidazole ,1 G
Cephalosporin , Erythro.
May transmit Hep B, Hep C, HIV
Fetal human cases of myelitis and
hemorrhagic encephalitis have been
reported following bites,scratches or eye
inoculation of saliva from monkeys.
Initial Sx: fever, headache,myalgias, diffuse
adenopathy,incubation period 2-14 days.
Limited information

Infection rate: 10%, Incubation: 10days4wks

Rat bite fever is caused by Spirillum minus
(Asia) , Streptobaccilus moniliformis (USA)
Rabies post exposure prophylaxis and
vaccination is not indicated for rat bites.
Serious complication: endocarditis (fetal)
Rabies prophylaxis may be indicated.
-flora in mouth may contain feces of the
previous prey

No specific antibiotic recommended. Cefadroxil

and cephalexin used in case reports.

Reference:
1. Sanford antimicrobial Guide 2014.
2. Animal Bite-associated Infections. Nicole Thomas, Itzhak Brook. Expert Rev Anti Infect Ther. 2011;9(2):215-226. Viewed on
medscape. URL: http://www.medscape.com/viewarticle/739023_11

Management of mamalian bit. Australian Family

Physician. Vol. 38, No. 11, November 2009

Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update
by the Infectious Diseases Society of America.