Dogs and cats are very important to millions of Canadians. Inmore than million cats and dogs were owned cat bite and augmentin pets in Canada and the United States. Bites from these animals are very common, with between one million and two million dog bites reported annually in both countries 1.
Five- to nine-year-old males sustain dog bites most frequently. Dog and cat bites occur most often in the summer, and between About half of these bites are considered to have been provoked. Children account for the majority of the 10 to 20 deaths from animal bites that occur annually in the United States 3. As a result, cat bite and augmentin, physicians need to diagnose appropriately and treat bite-related injuries that are potentially life-threatening. Dog bites typically cause puncture wounds, lacerations and crush injuries.
In a recent study involving patients, Talan et al 4 documented the microbiology of 50 infected dog bites and 57 infected cat bites. Pasteurella species, streptococci and staphylococci were the most common aerobes, while Fusobacterium species, Bacteroides and Porphyromonas were the most common anaerobes.
The appropriate treatment for dog and cat bites consists of the following: Tetanus immunization guidelines should be administered according to the Canadian Immunization Guide, 5th Edition Table 1 The decision to begin rabies immunotherapy should be made in conjunction with the local medical officer of health based on the immunization status of the animal in question, its behaviour as evaluated by a veterinarian and whether the attack was provoked.
Regardless of whether the animal is immunized, the local animal control agency should be notified so that they can quarantine the animal and keep it under observation for up to 10 days to see whether clinical symptoms develop.
Guide to tetanus prophylaxis in wound management adapted from Canadian Immunization Guide, 5th Edition. If prophylaxis is indicated for a child, the Canadian Immunization Guide, 5th Edition schedule for administering rabies immunoprophylaxis should be followed In situations where healthy animals are available for observation, the patient initially requires local wound treatment only.
An attempt should be made to infiltrate the full dose thoroughly into the wound and surrounding area. Any remaining volume should be injected intramuscularly at a site distant from the bite, such as the lateral thigh or gluteus muscle. In addition, a first dose of human diploid cell vaccine should be administered in the deltoid muscle as soon as possible, with additional doses given on days 3, 7, 14 and Care should be taken to ensure that appropriate psychological counselling is provided to children, particularly after savage attacks.
All wounds should be examined carefully, cat bite and augmentin. Some cat bite and augmentin may need deeper exploration because injuries that appear to be superficial may overlie fractures; involve lacerated tendons, vessels or nerves; extend into body cavities; penetrate joint spaces; or damage structures such as the eye.
In general, bite-related wounds should be treated and left open if they are punctures rather than lacerations, if they are not potentially disfiguring, if they involve the legs and arms particularly the hands as opposed to the face, or if the attack occurred more than 6 to 12 h earlier in the case of bites to the arms and legs, and 12 to 24 h earlier in the case of bites to the face 3.
Facial lacerations from dog or cat bites are usually closed. Foreign material increases the risk of infection, and sutures, particularly subcutaneous sutures, should be used sparingly. Adequate sedation must be given to children to allow proper wound exploration, decontamination and repair, when indicated.
In many cases, analgesia or anesthesia is needed for minor surgical procedures or proper debridement. Immediate cat bite and augmentin generous irrigation with soap and water, detergent or water alone at high pressures markedly decreases the concentration of bacteria in contaminated wounds and, most charles schulz and colon cancer, will substantially reduce the risk of rabies.
Debridement of devitalized tissue further decreases the likelihood of infection. Debridement must be performed cautiously on the face, particularly near landmarks, cat bite and augmentin, such as the vermilion border of the lip and the eyebrows. Debridement or suturing that may agitate a child or that involves particularly large wounds, or wounds with uneven or jagged edges may require a plastic surgery consultation.
Cultures obtained at the time of injury are of little value because they cannot be used to predict whether an infection will develop or to identify the causative pathogens if infection occurs 3.
However, when a bite shows evidence of infection, cultures should be taken to establish the etiological agent. P multocida infection typically develops within the first 24 h. Infected bites on hands and feet, in particular, may have bony involvement, and consideration should be given to the possibility of underlying osteomyelitis or infection of tendon sheaths.
Eight randomized trials involving prophylactic antibiotics for dog and cat bites have been published 7, cat bite and augmentin. Only one of these trials, which used amoxicillin-clavulanate, demonstrated a statistically significant reduction in infections 7. However, a trend to reduced infections was noted in four of the remaining seven studies, and a meta-analysis by Cummins 7 demonstrated a reduction in the risk of infection after prophylactic antibiotics relative risk 0.
There is no current economic evaluation of a strategy of universal prophylaxis versus no prophylaxis or prophylaxis only cat bite and augmentin special situations. Most experts currently recommend prophylactic antibiotics for the following situations only: The study by Talan et al 4 supported the use of an antibiotic, such as amoxicillin-clavulanate as the drug of choice, if needed, for prophylaxis before infection or for treatment once infection has become clinically apparent as noted by increasing swelling and erythema, which may be associated with streaking, cat bite and augmentin, warmth and tenderness.
Based on the bacteriology noted in the study, alternative oral agents for the treatment of infections caused by dog and cat bites are suggested in Table 3. Penicillin, ampicillin or firstgeneration cephalosporins alone will not cover the full spectrum of organisms identified in dog or cat bites, cat bite and augmentin.
P multocida is sensitive to penicillin, and to second- and third-generation cephalosporins, but it is resistant to cloxacillin, cephalexin, clindamicin and erythromycin. By contrast, S aureus usually is resistant to penicillin. Although azithromycin has not been studied, it displays in vitro activity against the common aerobic and anaerobic isolates from bite wounds when used as a single agent, and it may be useful for treatment 4 Municipal authorities should be encouraged to educate dog owners about their responsibilities with regard to training their pets; emphasis should be placed on discouraging aggressive behaviour when animals are young.
Whether this approach alone is sufficient or whether there also is a need to certify certain breeds of dogs as being dangerous is debatable. National Center for Biotechnology InformationU. Can J Infect Dis. Telephonefaxweb site http: This article has been cited by other articles in PMC. Open clomipramine and effexor a separate window. For persons who completed primary immunization after age seven years, three doses are sufficient.
Alternative oral agents include: PREVENTION Cat bite and augmentin authorities should be encouraged to cat bite and augmentin dog owners about their responsibilities with regard to training their pets; emphasis should be placed on discouraging aggressive behaviour when animals are young.
Incidence of dog bite injuries treated in emergency departments. A neglected problem in accident prevention. Am J Dis Child ; The management of bite wounds. Cat bite and augmentin Engl J Med ; Bacteriologic analysis of infected dog and cat bites. Ann Emerg Med ; 9: Prophylactic antibiotics in common dog bite wounds: Antibiotics to prevent infection in patients with dog bite wounds: A meta-analysis of randomized trials.
Ann Emerg Med ; Evaluation of prophylactic oxacillin in cat bite wounds. Review of 59 patients hospitalized with animal bites. Pediatr Infect Dis J ; 6: A clinical trial using co-trimoxazole in an attempt to reduce infection rates in dog bite wounds.
Postgrad Med ; Wound infection following dog bite despite prophylactic penicillin. Med J Eli lilly and strattera ; National Advisory Committee on Immunization.
Canadian Immunization Cat bite and augmentin, 5th edn. Canadian Medical Association, Committee on Infectious Diseases. Report of the Committee on Infectious Diseases. American Academy of Pediatrics, Microbiology of human cat bite and augmentin animal bite wounds in children. Comparative in vitro activities of azithromycin, bay ylevofloxacin, cat bite and augmentin, sparfloxacin, and 11 other oral antimicrobial agents against aerobic and anearobic bite wound isolates.