Bite wounds and antibiotic prescription among patients presenting to an Australian emergency department

Birdsey, Matthew; Edwards, Gail; Abetz, Jeremy; Jennings, Natasha; Mitra, Biswadev

doi:10.1016/j.ienj.2015.10.007

Cited by 12 publications

(14 citation statements)

References 10 publications

(12 reference statements)

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“…6,8 In human medicine, amoxicillin-clavulanic acid is the most common monotherapy for the empirical treatment of dog bite wounds. 10,13,30,32 In our study, amoxicillin-clavulanic acid had 96.2% and 91.3% susceptibility to gram-negative and gram-positive isolates, respectively. Most other studies have shown similar susceptibilities to amoxicillin-clavulanic acid between 85% and 100%.…”

Section: Discussionmentioning

confidence: 47%

“…9 A significant association between delayed presentation of greater than 8 h and clinically established infection was also demonstrated in a study investigating mammalian bite wounds in humans. 32 Culture samples taken at presentation of clinically non-infected wounds in dogs do not predict whether a wound will become infected, the infectious organism or the correct antimicrobial therapy. 3,9,12,36 In a polymicrobial infected wound, it is not possible to determine which are the causative species of infection and the nonpathogenic species.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of moderate grade dog bite wounds using amoxicillin–clavulanic acid with and without enrofloxacin: a randomised non‐inferiority trial

et al. 2021

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Background Dog-to-dog bite wounds are a common veterinary emergency presentation: despite this, there is insufficient information to guide veterinarians on appropriate empirical antimicrobial management.Objectives Investigate the effectiveness of amoxicillinclavulanic acid with and without enrofloxacin in the treatment of moderate grade dog bite wounds (DBW). To describe common pathogens and their antimicrobial susceptibility patterns.Materials and methods In a single-centre parallel group pragmatic trial, 50 dogs presenting with moderate grade DBW were prospectively randomised to receive amoxicillin-clavulanic acid (group A) or amoxicillin-clavulanic acid and enrofloxacin (group B). Swabs were taken for culture and susceptibility testing at admission. Stabilisation, wound care and surgical debridement were performed at the discretion of admitting clinicians. The primary outcome was complication due to infection at 10 days, with Bayesian inference used to estimate the difference in proportions between treatment groups.Results Of the 24 dogs in treatment group A, 1 required the addition of enrofloxacin at re-examination. None of the 26 dogs in group B required alteration of antimicrobial coverage. The difference in complication rate due to infection between treatment groups was 4.2%. Twenty-one different organisms were identified: Staphylococcus pseudintermedius, Neisseria spp., Pasteurella multocida and P. canis were the most common. Over 90% of gram-negative and gram-positive isolates were susceptible to amoxicillin-clavulanic acid. Ninety-six percent of gram-negative and 86% of gram-positive isolates were susceptible to enrofloxacin. Conclusion and clinical significanceAmoxicillin-clavulanic acid is an appropriate empirical antimicrobial choice for moderate DBW in South East Queensland. Reduced empirical enrofloxacin use will promote antimicrobial stewardship and potentially antimicrobial resistance.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Treatment of moderate grade dog bite wounds using amoxicillin–clavulanic acid with and without enrofloxacin: a randomised non‐inferiority trial

et al. 2021

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“…Targeted antibiotic therapy is important to prevent the development of resistance. Improper use of antibiotics is presumably due to the time pressure in medical treatment, a lack of familiarity with guidelines and disagreement with guidelines explained [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Microbiological Characteristics and Surgical Management of Animal-Bite-Related Oral & Maxillofacial Injuries: A Single Center’s Experience

et al. 2021

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The objective of the current study is to retrospectively evaluate animal-bite injuries and to gain insight into the epidemiology, accident consequences and treatment concept of these accidents in oral and maxillofacial surgery. Data of patients, who were admitted January 2015 and April 2021, were retrospectively evaluated regarding the patients’ characteristics (age, gender), facial distribution of substance defects/partial amputations, duration of hospitalization, operation treatments and antibiotic treatments. Data of 75 patients were included. Patients were bitten by dogs (n = 69.92%), cats (n = 4) and horses (n = 2). Lower eyelid/cheek complex was the most affected region (n = 37, 32.74%). Most of the patients between 0 and 3 years had to be operated on under general anesthesia (p = 0.011), while most of the adults could be operated on under local anesthesia (p = 0.007). In the age group 0–12 years, 30 patients (68%) were operated on under general anesthesia. Ampicillin/Sulbactam (48%) was the antibiotic most used. Antibiotics were adjusted after wound swabs in case of wound infections or critical wound conditions. This means that resistant antibiotics were stopped, and sensitive antibiotics were used. Structured surgical and antibiotic management of animal-bite wounds in the maxillofacial region is the most important factor for medical care to avoid long-term aesthetic consequences. Public health actions and policies under the leadership of an interdisciplinary committee could improve primary wound management, healing outcome and information status in the general population.

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“…However, no study has explored whether or not antibiotics have a beneficial effect after mamushi bites. Generally, animal bites are associated with the injection of bacteria into broken skin and prophylactic antibiotics may be required to prevent subsequent infection, in addition to proper wound care, such as inspection, debridement, and/or irrigation 25) . Some authors have recommended the routine prophylactic use of antibiotics after snake envenomation.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Significance of C-Reactive Protein in Patients with <i>Gloydius blomhoffii</i> Bite

Takeuchi

Ishikawa

Nagasawa

et al. 2019

Juntendo Medical Journal

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We retrospectively investigated the clinical significance of measuring the level of C-reactive protein (CRP) level in patients with mamushi (Gloydius blomhoffii) bites to differentiate it from bacterial cellulitis. Methods: We retrospectively conducted a medical chart review of all patients with mamushi bites who were treated in our department between July 2013 and August 2017. The patients were divided into two groups: the CRP-negative group included patients whose CRP levels were within the normal limit (< 0.3 mg/dl) during hospitalization, while the CRP-positive group included patients whose CRP levels were over the normal limit (≥0.3 mg/dl) during hospitalization. Results: Thirty-five cases were examined in this study. Seventeen patients were classified into the CRP-negative group and 18 were classified into the CRP-positive group. Only 2 of the patients (5%) had a positive CRP level on arrival. There were no significant differences in sex, ratio of delayed arrival, anti-venom administration, antibiotic administration, grade of mamushi bite on arrival and maximum grade of mamushi bite, ratio of increase in CRP over the normal limit, duration of hospitalization, or mortality rate between the two groups. However, the CRP-negative group tended to be younger than the CRP-positive group. Conclusion: This is the first report to show that 5% of mamushi bite cases had a positive CRP level on arrival, and that half had a positive CRP level during hospitalization. Future prospective studies involving a greater number of patients are needed in order to determine whether or not a lack of an increase in the CRP level on arrival is a useful biomarker for differentiating between mamushi bites and cellulitis.

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Bite wounds and antibiotic prescription among patients presenting to an Australian emergency department

Cited by 12 publications

References 10 publications

Treatment of moderate grade dog bite wounds using amoxicillin–clavulanic acid with and without enrofloxacin: a randomised non‐inferiority trial

Treatment of moderate grade dog bite wounds using amoxicillin–clavulanic acid with and without enrofloxacin: a randomised non‐inferiority trial

Microbiological Characteristics and Surgical Management of Animal-Bite-Related Oral & Maxillofacial Injuries: A Single Center’s Experience

The Clinical Significance of C-Reactive Protein in Patients with <i>Gloydius blomhoffii</i> Bite

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