Antibiotic choices for Bites – human and animal and body Boils

Bites – human and animal            (1)

animals bites

Management

Clean and debride wound thoroughly and assess the need for tetanus immunisation.
All infected bites should be treated with antibiotics. Prophylactic antibiotic treatment is appropriate for human and cat bites, or dog bites if severe or deep, and any bites that occur to the hand, foot, face, tendon or ligament, or in immunocompromised people.
Consider referral to hospital if there is bone or                                                                                          joint involvement.

human bites

Common pathogens

Polymicrobial infection, Pasteurella multocida, Capnocytophaga canimorsus (cat and dog bites), Eikenella corrodens (fist injury), Staphylococcus aureus, streptococci and anaerobes

Antibiotic treatment
Bites – human and animal

First choice
Amoxicillin clavulanate

Child: 10 mg/kg/dose (amoxicillin component), three times daily, for seven days (maximum 500 mg/dose, amoxicillin component)
Adult: 500+125 mg, three times daily, for seven days
Alternatives
Adult and child > 12 years: Metronidazole 400 mg, three times daily, + doxycycline 200 mg on day one, followed by 100 mg, once daily, on days two to seven
Metronidazole + co-trimoxazole is an alternative for children aged under 12 years (doxycycline contraindicated)

body Boils                      (2)

Management

Most lesions may be treated with incision and drainage alone.
Antibiotics may be considered if there is fever, surrounding cellulitis or co-morbidity, e.g. diabetes, or if the lesion is in a site associated with complications, e.g. face.
For management of recurrent boils, see: “Recurrent skin infections” (Page 14).
Common pathogens
Staphylococcus aureus
Consider MRSA if there is a lack of response to flucloxacillin.

Antibiotic treatment
Boils

First choice
Flucloxacillin

child ;12.5 mg/kg/dose, three to four times daily, for seven days

Adult: 500 mg, four times daily, for five to seven days

OR (if flucloxacillin not tolerated in children)

Cephalexin

Child: 12.5 – 25 mg/kg/dose, twice daily, for five to seven days

Alternatives

Cephalexin

Adult: 500 mg, four times daily, for five to seven days

Erythromycin

Child aged < 12 years: 20 mg/kg/dose, twice daily, or 10 mg/kg/dose, four times daily, for five to seven days (maximum 1 g/day)
Adult: 800 mg, twice daily, or 400 mg, four times daily, for five to seven days

Co-trimoxazole (if MRSA present):

Child > 6 weeks: 0.5 mL/kg oral liquid (40+200 mg/ 5 mL), twice daily, for five to seven days (maximum 20 mL/dose)
N.B. Co-trimoxazole should be avoided in infants aged under six weeks, due to the risk of hyperbilirubinaemia.
Adult and child >12 years: 160+800 mg (two tablets), twice daily, for five to seven days