Version May 2024
| Antibiotic | Adults | Children and infants >28 days old[1] | Duration of therapy |
| 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) 3 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* | Prophylaxis: 3 to 5 days Established infection: 5 to 14 days. Antibiotic therapy should be continued at least 1 to 2 days after symptoms and signs have resolved, usually not more than 7 days. Deep or complicated infections may require longer durations, particularly if a joint or bone is involved. |
| Alternate regimens include:¶ | |||
| Combination therapy with one of the following agents PLUS a second agent to cover anaerobes: | Prophylaxis: 3 to 5 days Established infection: 5 to 14 days. Antibiotic therapy should be continued at least 1 to 2 days after symptoms and signs have resolved, usually not more than 7 days. Deep or complicated infections may require longer durations, particularly if a joint or bone is involved. | ||
| Choose one of the following agents with activity against Pasteurella multocidaΔand Capnocytophaga: | |||
| Cefuroxime | 500 mg twice daily | 10 to 15 mg/kg twice daily (maximum 500 mg per dose) | |
| Doxycycline◊§ | 100 mg twice daily | 1 to 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) | |
| 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 3 times daily | 10 mg/kg 3 times daily (maximum 500 mg per dose) | |
| Clindamycin◊,** | 300 to 450 mg 3 times daily | 10 mg/kg 3 times daily (maximum 600 mg per dose) | |
| Monotherapy | |||
| Moxifloxacin‡,¶¶ | 400 mg daily | Not recommended; insufficient experience | |
The doses recommended above are intended for patients with normal renal function; the doses of some of these agents must be adjusted in patients with renal insufficiency.
Additional coverage for methicillin-resistant Staphylococcus aureus (MRSA) may be added in patients who have abscess, MRSA risk factors, or gram-positive cocci in clusters on Gram stain of the wound. Refer to the UpToDate topics on soft tissue infections due to dog and cat bites and MRSA treatment for recommendations.MRSA: methicillin-resistant Staphylococcus aureus; TMP-SMX: trimethoprim-sulfamethoxazole.
* The use of increased doses of amoxicillin-clavulanate may be considered in pediatric patients with infected bite wounds.
¶ The preferred regimen for children allergic to penicillin is combination therapy with clindamycin plus either TMP-SMX or an extended-spectrum cephalosporin. Alternative regimens for adults allergic to beta-lactams include combination therapy with either doxycycline, TMP-SMX, ciprofloxacin, or levofloxacin plus either metronidazole or clindamycin; moxifloxacin may be used as monotherapy if there are no other options.
Δ The following agents have unreliable or poor activity against P. multocida and should be avoided: first-generation cephalosporins (eg, cephalexin, cefadroxil), dicloxacillin, flucloxacillin, macrolides (eg, azithromycin).
◊ Doxycycline, TMP-SMX, and clindamycin may be active against MRSA. If clindamycin is used for MRSA, confirm susceptibility.
§ Data are scarce regarding doxycycline’s activity against bite-associated anaerobic bacteria. When using doxycycline for infected bites, we add an additional agent for anaerobic coverage; for prophylaxis of uninfected bites, some clinicians use it without adding additional anaerobic coverage.
¥ 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 class of antibiotics.[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 can be used as monotherapy but other options are preferable.[2]آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
