What is the treatment for Pasteurella multocida infection?

Treatment of Pasteurella multocida Infection

Penicillin or amoxicillin-clavulanate is the first-line treatment for Pasteurella multocida infections, with doxycycline as an excellent alternative for penicillin-allergic patients. 1, 2

First-Line Treatment Options

• Penicillin: Drug of choice for P. multocida infections 3, 4, 5

  • Oral: Penicillin 500 mg 4 times daily
  • IV: Penicillin G for severe infections

• Amoxicillin-clavulanate: Preferred for animal bite wounds (which commonly contain P. multocida)

  • Dosage: 875/125 mg twice daily orally 1, 2
  • Provides coverage against both P. multocida and other common bite wound pathogens

Alternative Treatments (for penicillin-allergic patients)

• Doxycycline: Excellent activity against P. multocida 1, 2

  • Dosage: 100 mg twice daily orally
  • Note: Some streptococci may be resistant

• Fluoroquinolones: Good activity against P. multocida 1, 2

  • Ciprofloxacin: 500-750 mg twice daily orally; 400 mg every 12h IV
  • Moxifloxacin: 400 mg daily orally or IV
  • Caution: May miss MRSA and some anaerobes

• Second/Third-generation cephalosporins: 1, 2

  • Cefuroxime: 500 mg twice daily orally; 1 g daily IV
  • Ceftriaxone: 1 g every 12h IV
  • Cefotaxime: 2 g every 6h IV

Treatment Duration

• Localized infections: 7-10 days 2
• Severe or systemic infections: 10-14 days
• Complicated infections (osteomyelitis, septic arthritis): 3-4 weeks 2

Special Considerations

Wound Management

• Thorough irrigation and debridement of necrotic tissue are crucial for preventing invasive wound infection 1
• Deep wounds, especially on hands, face, or near joints, require careful attention due to higher risk of complications 2

High-Risk Patients

• Immunocompromised patients, those with severe comorbidities, or deep/severe wounds require broad-spectrum antibiotics effective against both aerobic and anaerobic organisms 1
• Consider hospitalization for patients with systemic symptoms, deep infections involving tendons or joints, hand infections, or immunocompromised patients 2

Monitoring

• Assess response within 24-48 hours
• Monitor for signs of worsening infection (increasing erythema, pain, swelling, purulent discharge) 2
• Consider surgical consultation for deep infections, abscess formation, or necrotizing infections 2

Common Pitfalls and Caveats

1. Delayed treatment: P. multocida infections typically develop rapidly (within 12-24 hours after animal contact) and require prompt treatment 4

2. Inadequate coverage: While penicillin is effective against P. multocida, animal bite wounds often contain multiple pathogens requiring broader coverage (hence amoxicillin-clavulanate preference for bite wounds) 1

3. Beta-lactamase production: Although rare, some P. multocida strains may produce beta-lactamase, potentially causing treatment failure with penicillin alone 6, 5

4. Underestimating severity: P. multocida can cause not only localized infections but also serious complications including osteomyelitis, septic arthritis, and septicemia if not properly treated 3, 4

5. Missing the diagnosis: Always consider P. multocida in rapidly developing infections following animal contact, especially cat bites or scratches 4