From the Guidelines
For a 24-year-old exposed to large amounts of feces and urine, immediate decontamination is essential to prevent infection and reduce the risk of morbidity and mortality. The first step in management should be to have the person remove contaminated clothing and thoroughly wash exposed skin with soap and water for at least 20 seconds, as recommended for infection control in healthcare settings 1. Eyes should be irrigated with clean water if exposure occurred there. After cleaning, assess for any open wounds that may have been contaminated, as these require special attention. For contaminated wounds, clean thoroughly with soap and water, then consider prophylactic antibiotics such as amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days if the wound appears infected or was heavily contaminated. Some key points to consider in the treatment and prevention of infections after such exposure include:
- Avoiding contact with human and animal feces to prevent the transmission of pathogens like Cryptosporidium 1
- Washing hands after contact with human feces, handling pets, or gardening to reduce the risk of infection 1
- Avoiding sexual practices that might result in oral exposure to feces to prevent the transmission of pathogens 1
- Considering Hepatitis A vaccination if the person isn't already immunized, especially if the waste was of human origin
- Administering Tetanus prophylaxis (Tdap) if the patient hasn't received a booster within the past 5 years and has any wounds
- Monitoring for signs of infection including fever, increasing redness, swelling, or drainage from wounds, and gastrointestinal symptoms like nausea, vomiting, or diarrhea that may indicate infection and warrant medical attention. It is crucial to prioritize these measures to minimize the risk of infection and ensure the best possible outcome in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Evaluation and Treatment
The patient, a 24-year-old, has been exposed to a large amount of feces and urine. The primary concern is the risk of infection, particularly urinary tract infections (UTIs) and other bacterial infections.
Risk of Infection
- The patient is at risk of developing UTIs, as well as other bacterial infections such as spontaneous bacterial peritonitis (SBP) 2.
- The risk of infection is higher due to the exposure to feces and urine, which can contain harmful bacteria 3, 4, 5, 6.
Treatment Options
- Trimethoprim-sulfamethoxazole (TMS) and ciprofloxacin are commonly used antibiotics for the treatment and prophylaxis of UTIs and other bacterial infections 3, 4, 5, 6.
- Ciprofloxacin has been shown to be effective in preventing UTIs in renal transplant recipients 3 and in treating community-acquired UTIs 6.
- TMS has been shown to be effective in treating Isospora belli and Cyclospora cayetanensis infections in HIV-infected patients 4.
- Rifaximin has been shown to be effective in preventing SBP in cirrhotic patients with ascites 2.
Recommendations
- The patient should be evaluated for signs and symptoms of infection, such as fever, abdominal pain, and urinary symptoms.
- Antibiotic prophylaxis should be considered to prevent UTIs and other bacterial infections, with ciprofloxacin or TMS being potential options 3, 4, 5, 6.
- The patient should be monitored closely for signs of infection and adverse reactions to antibiotics 3, 4, 5, 6.