Mammalian bites: Difference between revisions

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===[[Tetanus]] Prophylaxis===
===[[Tetanus]] Prophylaxis===
ISDA suggests considering Tetanus Vaccination in patients whose last Vx was 10 years or more <ref>  Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of america. Clin Infect Dis. 2014 Jul 15;59(2):e10-52, executive summary can be found in Clin Infect Dis 2014 Jul 15;59(2):147 </ref>
IDSA suggests considering Tetanus Vaccination in patients whose last Vx was 10 years or more <ref>  Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of america. Clin Infect Dis. 2014 Jul 15;59(2):e10-52, executive summary can be found in Clin Infect Dis 2014 Jul 15;59(2):147 </ref>


==See Also==
==See Also==

Revision as of 16:49, 19 November 2015

Background

  • 5% of untreated dog bites will become infected (similar to rate of non-bite wounds)
  • 80% of untreated cat bites will become infected
  • Human Bite - (Also see Closed fist infection)

High-Risk Wounds

  • Cat, human, livestock, or monkey bites
  • Deep puncture wounds
  • Hand or foot wounds
  • Bites in immunosuppressed patients

Clinical Presentation

  • Depends on source of bite - bite marks or puncture wounds.

Differential Diagnosis

Envenomations, bites and stings

Diagnostic Evaluation

  • Clinical diagnosis, based on history and physical exam
  • Consider X-ray if concern for retained foreign body (e.g. tooth)

Management

Indications for Primary Closure of Mammalian Bites

  • Consider closure if all of the following are true:
    • Not a face or scalp wound
    • Repair can occur within 6hr of injury (time dependent upon individual judgment)
    • Repair only requires single-layer closure; no devitalized tissue
    • No underlying fracture
    • No systemic immunocompromising conditions

Antibiotics

Cat and Dog Bites

Coverage for Pasteurella, Strep, and Staph

  • Consider for high-risk wounds
    • wounds reaching the level of the muscle/tendon, wounds to the hand[1], violation of bone or joint capsule, immunocompromised hosts, wounds associated with significant local edema
  • Amoxicilin-clavulanate 875mg PO BID x 5-7 days OR[2]
  • Doxycycline 100mg PO BID x 14 days if penicillin allergic [3]
  • Clindamycin 450mg (5mg/kg) PO q8hrs daily x7 days PLUS

Human Bites

All human bites should be strongly considered for antibiotic therapy.[4]

Requires polymicrobial coverage for: S. aureus, Strep Viridans, Bacteroides, Coagulase-neg Staph, Eikenella, Fusobacterium, Cornebacterium, peptostreptococus

Mammalian Bites Severe Infections

Rabies prophylaxis

  • Rabies immune globulin should be inidividualized[5]
    • Indicated for bites from bats, monkeys, skunks, raccoons, foxes. In the U.S. rare for dog and cat bites

Tetanus Prophylaxis

IDSA suggests considering Tetanus Vaccination in patients whose last Vx was 10 years or more [6]

See Also

Video

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References

  1. EBQ:Antibiotic prophylaxis for mammalian bites
  2. Griego RD, Rosen T, Orengo IF, Wolf JE. Dog, cat, and human bites: a review. J Am Acad Dermatol. 1995;33:1019–29.
  3. Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med. 1999;340:85–92.
  4. EBQ:Antibiotic prophylaxis for mammalian bites
  5. Human rabies—Washington, D.C., 1995. MMWR Morb Mortal Wkly Rep. 1995;44:625–7.
  6. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of america. Clin Infect Dis. 2014 Jul 15;59(2):e10-52, executive summary can be found in Clin Infect Dis 2014 Jul 15;59(2):147