Version May 2024
| Antibiotic | Adults | Children and infants >28 days old[1] |
| Agent of choice: | ||
| Amoxicillin-clavulanate | 875/125 mg twice daily | 7:1 formulation: 22.5 mg/kg (amoxicillin component) twice daily (maximum 875 mg amoxicillin and 125 mg clavulanate per dose) or 4:1 formulation: 10 mg/kg (amoxicillin component) three times daily (maximum 500 mg amoxicillin and 125 mg clavulanate per dose) or 14:1 formulation: Not ideal for this use unless clinician increases the amoxicillin component dose to 45 mg/kg twice daily¶ |
| Alternate regimens includeΔ: | ||
| One of the following agents with activity against Eikenella corrodens◊: | ||
| Doxycycline§ | 100 mg twice daily | 1.1 to 2.2 mg/kg twice daily (maximum 100 mg per dose)¥ |
| TMP-SMX§ | 1 double-strength tablet twice daily | 4 to 6 mg/kg (trimethoprim component) twice daily (maximum 160 mg trimethoprim per dose) |
| Ciprofloxacin‡ | 500 to 750 mg twice daily | Use with caution in children <18 years of age†:
|
| Levofloxacin‡ | 750 mg daily | Use with caution in children <18 years of age†:
|
| plus | ||
| One of the following agents with anaerobic activity: | ||
| Metronidazole | 500 mg three times daily | 10 mg/kg three times daily (maximum 500 mg per dose) |
| Clindamycin§,** | 300 to 450 mg three times daily | 7.5 to 10 mg/kg three times daily (maximum 600 mg per dose) |
| or | ||
| Monotherapy with a fluoroquinolone: | ||
| Moxifloxacin‡,¶¶ | 400 mg daily | Not recommended; insufficient experience |
MRSA: methicillin-resistant Staphylococcus aureus; TMP-SMX: trimethoprim-sulfamethoxazole.
* The duration of antibiotic prophylaxis is 3 to 5 days; the duration of antibiotic therapy for established infection is 5 to 14 days.
¶ The use of increased doses of amoxicillin-clavulanate may be considered in pediatric patients with infected bite wounds.
Δ The preferred regimen for children allergic to penicillin is TMP-SMX or cefuroxime plus clindamycin (depending on liquid drug availability and palatability).[1] Alternative regimens for adults allergic to penicillin or beta-lactams include doxycycline, or TMP-SMX, or a fluoroquinolone (ciprofloxacin or levofloxacin) plus metronidazole, or moxifloxacin (may be used as monotherapy).
◊ The following agents have poor activity against E. corrodens and should be avoided: cephalexin, dicloxacillin, and erythromycin.
§ Doxycycline, TMP-SMX, and clindamycin may also be active against MRSA; susceptibility should be confirmed.
¥ Teeth staining can occur with repeated course of doxycycline among young children (<8 years); use with caution.
‡ In general, fluoroquinolones should be reserved for when other regimens are not options. If used, patients should be advised about the uncommon but potentially serious musculoskeletal, cardiac, and neurologic adverse effects associated with fluoroquinolones. Refer to UpToDate content for details.
† Use of fluoroquinolones in children should be limited to the treatment of infections for which no safe and effective alternative exists or in situations where oral therapy is a reasonable alternative to intravenous therapy with a different antibiotic class.[1]
** We generally avoid clindamycin, if possible, due to risk for Clostridium difficile infection and the possibility of streptococcal and staphylococcal resistance (refer to UpToDate content for details).
¶¶ Moxifloxacin has good anaerobic activity and may be used as monotherapy.[2]آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
