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Skin and Soft Tissue Infections

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21 Table 4. Recommended Therapy for Infections after Animal or Human Bites Antimicrobial Agent by Type of Bite Oral Intravenous Comments Animal Bite Amoxicillin/ clavulanate 875/125 mg bid … Some Gram-negative rods are resistant; misses MRSA Ampicillin- sulbactam … 1.5-3.0 g q6-8h Some Gram-negative rods are resistant; misses MRSA Piperacillin/ tazobactam … 3.37 g q6-8h Misses MRSA Carbapenems … See individual info. Misses MRSA Doxycycline 100 mg bid 100 mg q12h Excellent activity against Pasteurella multocida; some streptococci are resistant Penicillin plus dicloxacillin 500 mg qid/ 500 mg qid … SMX/TMP 160-800 mg bid 5-10 mg/kg/day of TMP component Good activity against aerobes; poor activity against anaerobes Metronidazole 250-500 mg tid 500 mg q8h Good activity against anaerobes; no activity against aerobes Clindamycin 300 mg tid 600 mg q6-8h Good activity against staphylococci, streptococci and anaerobes; misses P. multocida Second-generation cephalosporin Good activity against P. multocida; misses anaerobes Cefuroxime 500 mg bid 1 g q12h Cefoxitin … 1 g q6-8h ird-generation cephalosporin Ceriaxone … 1 g q12h Cefotaxime … 1-2 g q6-8h Fluoroquinolones Good activity against P. multocida; misses MRSA and some anaerobes Ciprofloxacin 500-750 mg bid 400 mg q12h Levofloxacin 750 mg daily 750 mg daily Moxifloxacin 400 mg daily 400 mg daily Monotherapy; good for anaerobes also

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