Polymicrobial:Pasteurella spp
Streptococcus spp
Staphylococcus spp/MRSA
Anaerobes
Capnocytophaga spp
Eikenella spp
Bergeyella spp
Neisseria spp
Moraxella spp
Corynebacterium spp
Enterococcus spp
Bacillus spp
Prophylaxis
Infection rate up to 20%. Prophylaxis within 12 hours of bite is recommended if:
- moderate/severe
- edema, pre-existing or resultant
- puncture wounds
- bone/joint involvement
- injuries to hand, foot, face, genitalia
- asplenic patients
- advanced liver disease
- immunocompromised patients.
| Empiric Therapy |
Dose |
Duration |
| Amoxicillin-clavulanate |
40mg/kg/d PO div tid |
3-5 days |
Alternative
| Empiric Therapy |
Dose |
Duration |
| Cefuroxime axetil |
30mg/kg/d PO div bid |
3-5 days |
| +/- |
|
|
| Metronidazole |
15-30mg/kg/d PO div bid |
|
ß-lactam allergy ≤ 8 years old
| Empiric Therapy |
Dose |
Duration |
| Clindamycin |
20mg/kg/d PO div tid |
3-5 days |
| + |
|
|
| TMP/SMX (if > 1 month old) |
8-12mg TMP/kg/d PO div bid |
|
ß-lactam allergy > 8 years old
| Empiric Therapy |
Dose |
Duration |
| Doxycycline |
2-4mg/kg/d PO div q12-24h |
3-5 days |
| +/- |
|
|
| Metronidazole |
15-30mg/kg/d PO div bid |
|
Treatment
| Empiric Therapy |
Dose |
Duration |
| Amoxicillin-clavulanate |
40mg/kg/d PO div tid |
7-10 days |
Alternative
| Empiric Therapy |
Dose |
Duration |
| Cefuroxime axetil |
30mg/kg/d PO div bid |
7-10 days |
| +/- |
|
|
| Metronidazole |
15-30mg/kg/d PO div bid |
|
ß-lactam allergy ≤ 8 years old
| Empiric Therapy |
Dose |
Duration |
| Clindamycin |
20-40mg/kg/d PO div tid |
7-10 days |
| + |
|
|
| TMP/SMX (if > 1 month old) |
8-12mg TMP/kg/d PO div bid |
|
ß-lactam allergy > 8 years old
| Empiric Therapy |
Dose |
Duration |
| Doxycycline |
2-4mg/kg/d PO div q12-24h |
7-10 days |
| +/- |
|
|
| Metronidazole |
15-30mg/kg/d PO div bid |
|
Severe/Limb-threatening
| Empiric Therapy |
Dose |
Duration |
| Piperacillin-tazobactam |
240-300mg piperacillin/kg/d IV div q6-8h |
10-14 days |
| or |
|
|
| Imipenem |
60mg/kg/d IV div q6h |
10-14 days |
