Dog Bite(PCN allergic)
Dog bites wounds can have polymicrobial infections including Pasteurella as well as other aerobic and anaerobic pathogens.
Dog bite wounds are typically mixed infections including Aerobic bacteria including Pasteurella, Streptococcus, Staphylococcus, Neisseria, and Corynebacterium species as well as Anaerobic bacteria including Fusobacterium nucleatum, Bacteroides tectus, and Prevotella species
Prophylaxis is indicated in some higher risk dog bites including wounds that are sutured closed (often facial bites), deep puncture wounds, bites in immunocompromised patients, hand wounds and those near joints.
Therapy is typically with Amoxicillin with Clavulanate which covers many of the common pathogens including Pasteurella. In penicillin allergic patients options include:
- Ciprofloxacin which covers Pasteurella along with clindamycin for broader anaerobic coverage.
- Doxycycline (Good activity against Eikenella species, Staphylococci, and anaerobes; some Streptococci are resistant)
- TMP/SMX (Good activity against aerobes; poor activity against anaerobes)
Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC; Infectious Diseases Society of America. 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. PMID: 24973422
Bradly JS (ed.) (2018) Nelson's Pediatric Antimicrobial Therapy 24th edition. Itasca, IL:American Academy of Pediatrics