22
Treatment
Table 4. Recommended Therapy for Infections after Animal
or Human Bites (continued)
Antimicrobial Agent by Type of Bite
Oral Intravenous Comments
Human Bite
Amoxicillin/
clavulanate
875/125 mg
bid
… Some Gram-negative rods are
resistant; misses MRSA
Ampicillin/
sulbactam
… 1.5-3.0 g q6h Some Gram-negative rods are
resistant; misses MRSA
Carbapenems See individual agents
Misses MRSA
Doxycycline 100 mg bid … Good activity against Eikenella
species, staphylococci, and anaerobes;
some streptococci are resistant
Table 5. Standard Doses of Antifungal Agents
Antifungal
agent Oral dose IV dose Comments
Fluconazole 100-400 mg q24h 800 mg loading
dose, then
400 mg daily
Candida krusei and
C. glabrata are resistant
Voriconazole
a
400 mg bid × 2
doses, then
200 mg q12h
6 mg/kg IV
q12h for 2 doses,
followed by
4 mg/kg IV q12h
Accumulation of
cyclodextrin vehicle with
IV formulation with renal
insufficiency
Posaconazole 400 mg bid
with meals
N/A Covers Mucorales
Lipid complex
amphotericin B
N/A 5 mg/kg/day Not active against fusaria
Liposomal
amphotericin B
N/A 3-5 mg/kg/day Not active against fusaria
a
e use of patient-specific pharmacokinetics is recommended to improve clinical outcome.
Table 6. Standard Doses of Antimicrobial Agents Active
Against Multiple Drug-Resistant Organisms
Antimicrobial IV dose Comments
Vancomycin 30-60 mg/kg/d in
2-4 divided doses
Target serum trough concentrations of
15-20 µg/mL in severe infections.
Daptomycin
4-6 mg/kg/day Covers VRE. Strains nonsusceptible to
vancomycin may be cross-resistant to
daptomycin.
Linezolid 600 mg q12h 100% oral bioavailability, so oral dose same as
IV dose. Covers VRE and MRSA.
Colistin 5 mg/kg load, then
2.5 mg/kg q12h
Nephrotoxic. Does not cover Gram-positives
or anaerobes, Proteus, Serratia, Burkholderia.
