Antibiotic Treatment for Infected Puncture Wound from Deer Processing
For an infected puncture wound sustained while cleaning a deer, amoxicillin-clavulanate 875/125 mg twice daily is the best antibiotic choice, as it provides comprehensive coverage against the polymicrobial flora typical of animal-related wounds, including aerobic and anaerobic bacteria. 1
Rationale for Antibiotic Selection
The microbiology of wounds from animal processing is complex and requires broad-spectrum coverage:
Primary pathogens include: Staphylococcus aureus, Streptococcus species, Pasteurella multocida (from animal tissue contact), and multiple anaerobic organisms including Fusobacterium, Prevotella, and Porphyromonas species 1
Amoxicillin-clavulanate provides optimal coverage for this polymicrobial environment, targeting both aerobic gram-positive cocci and anaerobes that commonly contaminate wounds from animal tissue 1
The standard adult dosing is 875/125 mg orally twice daily 1
Alternative Antibiotic Options
If amoxicillin-clavulanate is contraindicated due to penicillin allergy:
Doxycycline 100 mg twice daily provides excellent activity against Pasteurella multocida and most staphylococci, though some streptococci may be resistant 1
Moxifloxacin 400 mg daily as monotherapy offers good anaerobic coverage in addition to aerobic coverage 1
Combination therapy with ciprofloxacin 500-750 mg twice daily PLUS metronidazole 250-500 mg three times daily covers both aerobic and anaerobic organisms 1
Antibiotics to Avoid
First-generation cephalosporins (cephalexin, cefazolin) have poor activity against Pasteurella multocida and anaerobes and should be avoided 1
Clindamycin alone misses Pasteurella multocida despite good staphylococcal and anaerobic coverage 1
Macrolides (erythromycin) have poor activity against Pasteurella multocida 1
Critical Adjunctive Measures
Beyond antibiotics, proper wound management is essential:
Tetanus prophylaxis is mandatory if vaccination status is not current within 10 years; Tdap is preferred over Td if not previously given 1
Wound care: Cleanse with sterile normal saline, perform cautious debridement if needed, and do NOT primarily close infected puncture wounds 1
Elevation of the affected extremity accelerates healing, especially if swelling is present 1
Duration of Therapy
Uncomplicated soft tissue infection: 7-10 days of oral antibiotics 1, 2
Hand wounds or puncture wounds warrant immediate antibiotic treatment given higher risk of complications including septic arthritis and osteomyelitis 1, 3
If osteomyelitis develops: 4-6 weeks of therapy is required 1
When to Escalate Care
Seek immediate surgical consultation if:
Signs of systemic toxicity develop (fever >38.5°C, tachycardia >110 bpm, hypotension) 1
Erythema extends >5 cm beyond wound margins 1
Pain disproportionate to injury suggesting deeper infection (osteomyelitis, septic arthritis) 1
Necrotizing infection suspected (requires broad-spectrum IV antibiotics: vancomycin or linezolid PLUS piperacillin-tazobactam or carbapenem) 1
Common Pitfalls
Do not use monotherapy with agents lacking anaerobic coverage (fluoroquinolones alone, TMP-SMX alone) as anaerobes are present in 50-65% of animal-related wounds 1
Puncture wounds have higher infection rates than lacerations and require more aggressive initial treatment 3
Follow-up within 24 hours is essential to ensure infection is not progressing despite appropriate therapy 1