What is the recommended antibiotic for a rabbit bite?

Recommended Antibiotic for Rabbit Bite

For rabbit bites, amoxicillin-clavulanate is the recommended first-line antibiotic due to its coverage of both aerobic and anaerobic bacteria commonly found in animal bite wounds. 1

Rationale for Antibiotic Selection

• Rabbit bites, like other animal bites, contain a complex mix of aerobic and anaerobic bacteria that require broad-spectrum coverage 1
• Amoxicillin-clavulanate (875/125 mg twice daily for adults) provides effective coverage against the polymicrobial nature of these wounds 1
• This recommendation is supported by strong evidence (strong, moderate) from the Infectious Diseases Society of America guidelines 1

Microbiology of Rabbit Bites

• Similar to other animal bites, rabbit bites can contain:
  • Pasteurella species (commonly found in 50-75% of animal bites) 1
  • Staphylococci and streptococci (found in approximately 40% of animal bites) 1
  • Anaerobic bacteria including Bacteroides, Fusobacterium, Porphyromonas, and Prevotella species 1

Alternative Antibiotic Options

If amoxicillin-clavulanate cannot be used, consider:

• Oral alternatives:

  • Doxycycline (100 mg twice daily) - excellent activity against Pasteurella multocida, though some streptococci may be resistant 1
  • Penicillin plus dicloxacillin (500 mg four times daily each) 1
  • Moxifloxacin (400 mg daily) - provides good anaerobic coverage as monotherapy 1

• Intravenous options (for severe infections):

  • Ampicillin-sulbactam (1.5-3.0 g every 6-8 hours) 1
  • Piperacillin-tazobactam (3.37 g every 6-8 hours) 1
  • Carbapenems (dosing varies by specific agent) 1
  • Second-generation cephalosporins like cefuroxime (1 g every 12 hours IV) or cefoxitin (1 g every 6-8 hours IV) 1

Duration of Therapy

• For prophylaxis or early treatment: 3-5 days 1
• For established infections: typically 7-14 days, depending on severity 1

Indications for Antibiotic Prophylaxis

Preemptive early antimicrobial therapy is recommended for patients with any of the following risk factors:

• Immunocompromised status 1
• Asplenia 1
• Advanced liver disease 1
• Preexisting or resultant edema of the affected area 1
• Moderate to severe injuries, especially to the hand or face 1
• Injuries that may have penetrated the periosteum or joint capsule 1
• Presentation >9 hours after injury 1

Important Clinical Considerations

• Wound management: Thorough cleaning and copious irrigation with normal saline is essential before antibiotic administration 2, 3
• Tetanus prophylaxis: Administer tetanus toxoid if vaccination is not current (within 10 years). Tdap is preferred over Td if not previously given 1
• Rabies consideration: Although uncommon in rabbits, consultation with local health officials is recommended to determine if rabies prophylaxis is indicated 1
• Wound closure: Primary closure is generally not recommended except for facial wounds 1

Common Pitfalls to Avoid

• Inadequate spectrum coverage: Avoid using first-generation cephalosporins (e.g., cephalexin), penicillinase-resistant penicillins (e.g., dicloxacillin), macrolides, or clindamycin alone as they have poor activity against Pasteurella species 1
• Delayed treatment: Early antibiotic administration (within 24 hours of injury) is crucial for preventing infection in high-risk wounds 1, 3
• Overlooking deeper structures: Always evaluate for potential damage to tendons, nerves, blood vessels, and bone, especially with puncture wounds 3
• Inappropriate wound closure: Infected wounds should not be closed; consider delayed primary or secondary closure 1