From the Guidelines
For an infected human bite wound with cellulitis, the recommended antibiotic therapy is amoxicillin-clavulanate (Augmentin) 875/125 mg orally twice daily for 5-7 days, as it provides broad coverage against both aerobic and anaerobic bacteria, including Streptococcus species, Staphylococcus aureus, Eikenella corrodens, and oral anaerobes 1.
Key Considerations
- Human bite infections require coverage for both aerobic and anaerobic bacteria, including Streptococcus species, Staphylococcus aureus, Eikenella corrodens, and oral anaerobes.
- Amoxicillin-clavulanate provides this broad coverage effectively, but it may not be effective against MRSA 1.
- If the patient has a penicillin allergy, alternatives include clindamycin 300-450 mg orally four times daily plus either ciprofloxacin 500 mg twice daily or trimethoprim-sulfamethoxazole (TMP-SMX) one double-strength tablet twice daily.
Wound Management
- The wound should be thoroughly cleaned, irrigated with sterile saline, and any devitalized tissue should be debrided.
- Elevation of the affected area and warm compresses can help reduce swelling.
- The infection should be reassessed after 48-72 hours of treatment to ensure improvement.
Potential Complications
- If the infection worsens despite appropriate antibiotic therapy, or if there are signs of deeper infection such as fever or lymphangitis, hospitalization for intravenous antibiotics may be necessary.
- Broader empirical coverage for abscesses might yield better therapeutic results, and a more focused therapy for nonpurulent infected wounds could allow narrower therapy 1.
From the FDA Drug Label
The two trials were similar in design but differed in patient characteristics, including history of diabetes and peripheral vascular disease. There were a total of 534 adult patients treated with daptomycin for injection and 558 treated with comparator in the two trials. The comparator: vancomycin (1 g IV q12h) or an anti-staphylococcal semi-synthetic penicillin (i.e., nafcillin, oxacillin, cloxacillin, or flucloxacillin; 4 to 12 g/day IV in divided doses). Table 15: Investigator’s Primary Diagnosis in the cSSSI Trials in Adult Patients (Population: ITT) Primary Diagnosis Adult Patients (Daptomycin for Injection/ Comparator* ) Wound Infection 99 (38%) / 116 (44%)
The next best antibiotic therapy for an infected human bite wound with cellulitis could be vancomycin or an anti-staphylococcal semi-synthetic penicillin (such as nafcillin, oxacillin, cloxacillin, or flucloxacillin), as these were used as comparators in the clinical trials for daptomycin and showed similar efficacy in treating complicated skin and skin structure infections, including wound infections 2.
From the Research
Antibiotic Therapy for Infected Human Bite Wound with Cellulitis
- The most common pathogens causing infections from human bites are gram-positive bacteria, such as Streptococcus spp. 3, 4
- Beta-lactam antibiotics, like cephalosporins, are commonly used to treat cellulitis infections 5
- Amoxicillin-clavulanate is considered to offer the best in vitro coverage of the pathogenic flora in infected human bites 6
- A combination therapeutic regimen of amoxicillin + clavulanic acid has been linked to the shortest duration of hospital stay in patients with erysipelas or bacterial cellulitis 7
- Prophylactic antibiotic treatment should be given after a human bite to prevent infection, and if infection signs and symptoms develop, rapid diagnosis, appropriate antibiotic, and surgical therapy should be administered immediately 4
Recommended Antibiotic Options
Important Considerations
- The need for prophylaxis against systemic infectious complications, particularly tetanus, should be evaluated 6
- Initial wound management, including irrigation and debridement, is crucial for preventing infection 6
- Patients with certain conditions, such as chills on admission, coexisting chronic venous insufficiency, or anemia, may require longer hospitalization and closer monitoring 7