What guidelines support the use of Augmentin (amoxicillin-clavulanate) in the treatment of animal bites?

From the Guidelines

Augmentin (amoxicillin-clavulanate) is recommended as first-line therapy for animal bite wound infections due to its broad-spectrum coverage against the polymicrobial organisms typically found in these wounds. According to the 2014 update by the Infectious Diseases Society of America 1, the recommended oral dosage for animal bites is 875/125 mg twice daily. This guideline supports the use of augmentin in animal bites, as it covers both aerobic and anaerobic bacteria commonly found in animal bites, including Pasteurella species, Staphylococcus, Streptococcus, and various anaerobes.

Some key points to consider when using augmentin for animal bites include:

• The importance of initiating treatment as soon as possible after the bite, ideally within 8 hours for high-risk wounds
• The need for prophylactic antibiotics in high-risk bites, including hand wounds, puncture wounds, cat bites, facial bites, and in immunocompromised patients
• Alternative treatments for patients with penicillin allergies, such as doxycycline, trimethoprim-sulfamethoxazole plus clindamycin, or a fluoroquinolone plus clindamycin
• The potential for augmentin to miss certain pathogens, such as MRSA, and the need for broader empirical coverage for abscesses or more focused therapy for nonpurulent infected wounds 1.

Overall, the use of augmentin in animal bites is supported by the guidelines due to its broad-spectrum coverage and effectiveness against the polymicrobial organisms typically found in these wounds.

From the FDA Drug Label

Skin and Skin Structure Infections − caused by β-lactamase−producing strains of S. aureus, E. coli, and Klebsiella spp. The use of Amoxicillin/Clavulanic Acid (Augmentin) is supported in the treatment of skin and skin structure infections, which may include animal bites.

• The drug is effective against β-lactamase−producing strains of certain bacteria, which may be present in animal bites.
• However, it is essential to note that the drug label does not explicitly mention animal bites as an indication.
• The decision to use Augmentin in animal bites should be based on clinical judgment and consideration of local epidemiology and susceptibility patterns 2.

From the Research

Guideline for Using Augmentin in Animal Bites

The use of Augmentin (amoxicillin/clavulanate) in animal bites is supported by several studies.

• The choice of antibiotic is controversial, but initial empirical treatment generally relies on broad-spectrum coverage 3.
• A comparative double-blind study found that amoxicillin/clavulanate reduced the infection rate in older wounds (presenting 9-24 h after injury) 4.
• The study suggests that the use of Augmentin may be beneficial in preventing infection after animal bites, especially in wounds that are 9-24 hours old 4.
• Basic irrigation, debridement, and wound culture are common to almost every animal and should be the first step in treatment, followed by antimicrobial treatment guided by the most commonly presenting pathogens specific to certain animals 5.
• It is crucial to understand the pathogens associated with different animal bites to develop and execute appropriate management plans, including specific antimicrobial treatment 5.

Key Considerations

• The type of animal involved, specific nature of the wound, circumstances of the attack, interval between injury and treatment, and location of the bite should be considered when evaluating animal bites 3.
• Rabies prophylaxis is indicated for bites by carnivorous wild animals, bats, and unvaccinated domestic animals 3, 6.
• Review of the patient's tetanus status is mandatory 3, 6.
• The use of antibiotic prophylaxis is controversial, but most authorities agree that it is needed for hand wounds, puncture wounds, or "dirty" wounds of any type in any location 3.