Adult Outpatients: Skin and Soft-Tissue Infections: Bites

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Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Consider evaluation for tetanus prophylaxis for all bites. 

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

Bites

Dog and Cat 

Streptococci

Pasteurella spp.*

Staphylococci

Oral anaerobes

 

Amoxicillin/clavulanate

875 mg/125 mg PO BID

 

Prophylaxis – x 5 days

Treatment – x 10 days  

For severe PCN allergy

Clindamycin 300 mg PO TID

PLUS ONE OF:

Ciprofloxacin 500 mg PO BID

OR

Levofloxacin 500 mg PO daily

 

Only 5% of dog bites become infected, whereas 30-50% of cat bites become infected.

 

Prophylaxis in high risk patients or in high risk bite only:


High risk patient
= post splenectomy, immunocompromised

 

High risk bite = hand or foot

*P.multocida is resistant to cephalexin & clindamycin; many strains are resistant to erythromycin but sensitive to fluoroquinolones, doxycycline and penicillin.

Bites

Human

Viridans streptococci

Eikenella*

Oral anaerobes

Amoxicillin/clavulanate 875 mg/125 mg PO BID

 

Prophylaxis – x 5 days

Treatment – x 10 days  

For severe PCN allergy:

Clindamycin 300 mg PO TID

PLUS ONE OF:

Ciprofloxacin 500 mg PO BID

OR

Levofloxacin500 mg PO daily

OR

TMP/SMX One DS tablet PO BID

 
*Eikenella resistant to clindamycin, metronidazole, 1st gen cephalosporins and erythromycin; susceptible to fluoroquinolones, clarithromycin, doxycycline, amoxicillin/clavulanate and TMP/SMX.