From the Guidelines
A dog bite patient on IV vancomycin, ceftriaxone, and metronidazole can be converted to oral antibiotics when they show clinical improvement, as evidenced by reduced pain, swelling, and erythema, absence of fever for 24-48 hours, and normalization of inflammatory markers, as suggested by the 2018 WSES/SIS-E consensus conference recommendations 1. The decision to transition from intravenous to oral antibiotics is based on the severity of the infection and the patient's clinical response to treatment.
- For mild infections, oral therapy is recommended.
- For severe infections, intravenous therapy is preferred, but the goal should be to transition to oral therapy as soon as possible, once clinical improvement is documented, to positively impact length of stay, as noted in the 2018 consensus conference 1. Key considerations before switching to oral therapy include:
- The patient's ability to tolerate oral medications.
- The absence of signs of deep tissue infection, osteomyelitis, or septic arthritis, which would require longer IV treatment. The oral antibiotic regimen should be chosen to cover the polymicrobial nature of dog bite infections, including aerobic bacteria like Pasteurella, Streptococcus, and Staphylococcus species, as well as anaerobes like Fusobacterium and Bacteroides.
- A standard oral regimen could include amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for a total of 7-14 days of combined IV and oral therapy.
- For patients with penicillin allergies, alternatives include doxycycline 100 mg twice daily, or a combination of clindamycin 300-450 mg three times daily plus either trimethoprim-sulfamethoxazole or a fluoroquinolone, although the specific choice should be guided by the most recent and highest quality evidence available, which in this context, is the 2018 WSES/SIS-E consensus conference recommendations 1.
From the Research
Conversion to Oral Antibiotics
When a dog bite patient is on IV vancomycin, ceftriaxone (Rocephin), and metronidazole (Flagyl), the decision to convert to oral antibiotics depends on several factors, including the severity of the bite wound, the patient's overall health, and the presence of any complications.
Factors Influencing Conversion
- The patient's ability to tolerate oral medications and absorb them effectively 2
- The severity of the bite wound and the risk of infection 3, 4
- The presence of any underlying medical conditions that may affect the patient's immune system or increase the risk of infection 5
- The results of culture and susceptibility testing, which can help guide the selection of oral antibiotics 6
Oral Antibiotic Options
- Amoxicillin-clavulanate is a commonly recommended oral antibiotic for dog bite wounds, as it provides broad-spectrum coverage against common pathogens 3, 6
- Other oral antibiotics, such as cephalexin or dicloxacillin, may also be effective, but the choice of antibiotic should be based on the specific circumstances of the patient and the wound 4
Timing of Conversion
- The decision to convert to oral antibiotics should be made on a case-by-case basis, taking into account the patient's individual needs and the severity of the wound 2
- In general, patients who are clinically improving and have no signs of complications can be considered for conversion to oral antibiotics 6