Prophylactic oral antibiotics for low-risk dog bite wounds. Wound infection following dog bite despite prophylactic penicillin. Management of early human bites of the hand: a prospective randomized study. The use of antibiotics in the initial management of recent dog-bite wounds. Prophylactic oxacillin in dog bite wounds. Dog bites in children: epidemiology, microbiology, and penicillin prophylactic therapy. Evaluation of prophylactic oxacillin in cat bite wounds.
The use of prophylactic antibiotics in the initial treatment of noninfected dog bite wounds is controversial. All patients with noninfected dog bite wounds who presented to our emergency department (ED) over a two-year period were considered for entry into a randomized prospective study. Patients were excluded from the study if they had any high-risk criteria for infection: puncture wounds, hand or foot wounds, wounds greater than 12 hours old, a history of immunocompromising disorders, or the use of immunosuppressive drugs. Patients in the antibiotic group (n = 89) were treated with local wound care and given either dicloxacillin, cephalexin, or erythromycin orally for seven days. Patients in the control group (n = 96) received local wound care only. All patients had their wounds irrigated with a 1% povidone-iodine solution and debrided and sutured if clinically indicated. All patients were subsequently reevaluated for clinical signs of wound infection. The groups were similar in age, sex, time of delay in seeking treatment, anatomic sites of wounds, depths and types of wounds, and number of wounds requiring suturing. The wound infection rates for the antibiotic and control groups were 1.1 and 5.1%, respectively. This difference was not significant (P = 0.212). There were 36 wounds in the antibiotic group and 37 wounds in the control group that were full thickness. The infection rates for these wounds were 2.8 and 13.5%, respectively. This was not statistically significant (P = 0.132). This study suggests that prophylactic oral antibiotics in low-risk dog bite wounds are not indicated. Dog bite wounds of 39 children (ages one to 16 years) were cultured and irrigated. Cultures showed various organisms but were of no predictive value for development of infection. By using a table of random numbers, patients were assigned to either oral penicillin V-K (100,000 U/kg/day every 6 h) or placebo for two days. All patients were seen in follow-up in three to four days and again at seven to 10 days or earlier if signs of inflammation occurred. The mean patient age, location and type of wound, and initial wound care were similar in the two treatment groups. Three of 39 (7.7%) children enrolled in the study developed infection at the bite site, including two of 19 in the penicillin group and one of 20 in the placebo group. In our study, prophylactic penicillin failed to prevent infection in dog bite wounds. Good local care on presentation seems to be the most important factor in determining future infection. A prospective, randomized study was undertaken to determine if mechanical care of early human bites alone is sufficient therapy in the compliant patient or if prophylactic antibiotics (oral versus parenteral) are indicated. Beginning in June of 1985, patients presenting with human bites of the hand were entered into the study if (1) the bite was less than 24 hours old, (2) the patient was free of infection, (3) the bite did not penetrate the joint capsule, and (4) there was no injury to tendon. Forty-eight patients were ultimately segregated into one of three study groups after standardized ER mechanical wound care. Fifteen patients received an oral placebo, with 7 developing infection (46.7 percent). Sixteen patients received an oral antibiotic, and 17 patients received parenteral antibiotics. No infections were found in either of these latter groups. The results statistically substantiate that mechanical wound care alone is insufficient therapy. Oral antibiotics appear to be equal to intravenous antibiotics for prophylaxis. From a cost-benefit standpoint, vigorous cleaning, debridement, and coverage with a broad-spectrum oral antibiotic are adequate care for an uncomplicated bite in the compliant patient. The use of antibiotics in the initial management of dog-bite wounds presented within eight hours of injury was studied. Of 211 wounds occurring in 150 patients seen during the study period, 66 wounds occurring in 33 patients comprised the study sample. All wounds were managed according to a strict protocol that included cleaning, debridement, and pressure irrigation. The wounds studied were randomly assigned to either an antibiotics (penicillinase-resistant penicillin or erythromycin) or placebo group. Two of the 35 antibiotic-treated wounds became infected, and three of the 31 placebo-treated wounds became infected. There was no significant difference in outcome between antibiotic and placebo groups. Hand wounds became infected significantly more often than other wounds. The administration of a penicillinase-resistant antibiotic is not indicated in the initial management of dog-bite wounds presented within eight hours of injury. This prospective, double-blind, placebo-controlled study was undertaken to determine the value of prophylactic oxacillin in dog bites. Adult patients with uninfected full-thickness wounds presenting within 24 hours of injury were considered. Management consisted of cleansing, irrigation, debridement, and closure as indicated; no topical antibiotics were applied. Patients were randomly assigned to receive oxacillin 500 mg QID x 5 days or identically appearing placebo. Home wound care was standardized an patients were observed at least every 2 days. Clinical assessment of infection was confirmed microbiologically. Sixty-three patients were admitted and 46 completed the study. Oxacillin (22) and placebo (24) groups were identical in sex, age, number of wounds per patient, wound location and type, number of open and closed wounds, delay to presentation, length of follow-up observation, medication compliance, and adequacy of patient wound care. Two infections of the hand occurred in patients receiving oxacillin; no infections were seen among placebo-treated patients (P = NS). Prophylactic oxacillin was not associated with improved outcome. We do not advise the use of prophylactic antibiotics in dog bite injuries treated within 24 hours of accident. Fifty-five children with nonfacial dog bites were prospectively studied. Patients were assigned to an experimental group receiving oral penicillin or a control group receiving local wound care only. Wounds were cultured for anaerobic and aerobic flora prior to cleansing. Results showed that most children were bitten on an extremity by a familiar dog, sustained simple injuries, and sought prompt medical attention. The overall infection rate was 3.6%, with one patient in each group developing an infection. The most frequently recovered organisms were normal skin flora. No Pasteurella multocida were isolated. Forty percent of cultures yielded potential pathogens. Despite this finding, initial cultures of dog bite wounds had no value in predicting subsequent infection. This study suggests that routine use of prophylactic penicillin is not required for simple nonfacial dog bites in children. A prospective, double-blind, placebo-controlled study was undertaken to determine the influence of prophylactic oxacillin on the frequency of infection in cat bite wounds. Adult patients with uninfected full-thickness wounds presenting within 24 hours of injury were considered. Emergency department management consisted of cleansing, irrigation, debridement, and closure as indicated; no topical antibiotics were applied. Patients were randomly assigned to receive oxacillin 500 mg qid for five days or identically appearing placebo. Home wound care was standardized and patients were observed at least every two days for a minimum of five days, or until wounds were sufficiently healed to allow discharge from the study. Clinical assessment of infection was confirmed microbiologically when possible. Twelve patients were admitted and 11 completed the study. Oxacillin (n = 5) and placebo (n = 6) groups were identical in sex, age, number of wounds per patient, wound location and type, delay to emergency department presentation, length of follow-up observation, medication compliance, and adequacy of home wound care. Four of six patients receiving placebo, but none of the five receiving oxacillin, developed a wound infection (P = .045). Material obtained from three of these four patients yielded Pasteurella multocida as the responsible organism. Prophylactic oxacillin was thus associated with a significant reduction in the frequency of infection following cat bites. We recommend such therapy in the care of these wounds.
There is evidence from one trial that prophylactic antibiotics reduces the risk of infection after human bites but confirmatory research is required. There is no evidence that the use of prophylactic antibiotics is effective for cat or dog bites. There is evidence that the use of antibiotic prophylactic after bites of the hand reduces infection but confirmatory research is required.