What is the recommended treatment for Pasteurella multocida infections?

Treatment of Pasteurella multocida Infections

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

First-Line Treatment Options

Oral Treatment

• Amoxicillin-clavulanate: 875/125 mg twice daily 2, 1

  • Preferred for animal bite wounds due to broad coverage against P. multocida and other common bite wound pathogens
  • Effective against both aerobic and anaerobic bacteria commonly found in animal bites

• Penicillin: Highly effective against P. multocida 3

  • No beta-lactamase producing isolates were found in recent studies 4

Intravenous Options (for severe infections)

• Ampicillin-sulbactam: 1.5-3.0 g every 6 hours 2
• Piperacillin-tazobactam 2
• Carbapenems (ertapenem, imipenem, meropenem) 2

Alternative Options for Penicillin-Allergic Patients

• Doxycycline: 100 mg twice daily 2, 1, 5

  • Excellent activity against P. multocida
  • Note: Some streptococci may be resistant

• Fluoroquinolones 2, 1

  • Ciprofloxacin: 500-750 mg twice daily
  • Levofloxacin: 750 mg daily
  • Moxifloxacin: 400 mg daily (good for anaerobes as well)
  • Caution: May miss MRSA and some anaerobes

• Second/Third-generation cephalosporins 2, 1

  • Cefuroxime: 500 mg twice daily (oral); 1 g every 12 hours (IV)
  • Ceftriaxone: 1 g every 12 hours (IV)
  • Cefotaxime: 1-2 g every 6-8 hours (IV)

Inappropriate Antibiotic Choices

The following antibiotics should be avoided due to poor activity against P. multocida:

• First-generation cephalosporins (e.g., cephalexin)
• Penicillinase-resistant penicillins (e.g., dicloxacillin)
• Macrolides (e.g., erythromycin)
• Clindamycin alone 2

Treatment Duration

• Localized infections: 7-10 days 1
• Severe or systemic infections: 10-14 days 1
• Complicated infections (osteomyelitis, septic arthritis): 3-4 weeks 2, 1

Wound Management

1. Immediate wound care:

   • Thorough irrigation with sterile normal saline 2
   • Remove superficial debris 2
   • Avoid primary closure of wounds (except facial wounds) 2

2. Monitoring:

   • Assess response within 24-48 hours 1
   • Monitor for signs of worsening infection (increasing erythema, pain, swelling, purulent discharge) 1

Special Considerations

High-Risk Patients

• Immunocompromised patients
• Elderly
• Patients with cirrhosis or asplenia
• Patients with severe comorbidities
• Deep/severe wounds

These patients require:

• Broader spectrum antibiotics
• Closer monitoring
• Possible hospitalization 1

Indications for Hospitalization

• Severe infections with systemic symptoms
• Deep infections involving tendons or joints
• Hand infections
• Immunocompromised patients with moderate to severe infections 1

Complications

Infectious complications requiring prolonged therapy include:

• Septic arthritis
• Osteomyelitis (4-6 weeks of therapy)
• Subcutaneous abscess formation
• Tendonitis
• Bacteremia (rare) 2

P. multocida infections typically respond well to appropriate antibiotic therapy when initiated promptly, but can lead to serious complications if treatment is delayed, particularly in high-risk populations.

2, 1, 3