What is the best antibiotic for a cut sustained while cleaning a deer?

Antibiotic Management for Deer Cleaning-Related Lacerations

Amoxicillin-clavulanate (875/125 mg twice daily) is the first-line antibiotic for cuts sustained while cleaning deer, as it provides comprehensive coverage against the polymicrobial contamination typical of animal-related wounds, including Pasteurella multocida, anaerobes, and environmental bacteria. 1

Rationale for Amoxicillin-Clavulanate

• Deer cleaning injuries are contaminated traumatic wounds with high risk of polymicrobial infection from animal flora, environmental bacteria, soil organisms, and anaerobes 2
• The American College of Physicians specifically recommends amoxicillin-clavulanate as first-line treatment for animal-related wounds due to its broad coverage of both aerobic and anaerobic bacteria commonly found in these wounds 1
• This combination provides coverage against Pasteurella multocida (a key pathogen in animal-related wounds), gram-negative organisms, streptococci, staphylococci, and anaerobes 1
• The clavulanate component protects against beta-lactamase producing organisms that may be present in contaminated wounds 2

Alternative Options for Penicillin Allergy

• Mild penicillin allergy: Cefuroxime provides good coverage against P. multocida but has reduced anaerobic coverage 1
• Severe penicillin allergy: Doxycycline offers excellent activity against P. multocida and good coverage of many other potential pathogens 1

Treatment Duration

• Standard course: 5-7 days for uncomplicated wounds with proper cleaning and debridement 1
• Extended course: 7-10 days for more severe or heavily contaminated wounds 1

Critical Management Steps Beyond Antibiotics

• Immediate wound care: Thorough irrigation and debridement of devitalized tissue must be performed before antibiotic administration 2
• Timing matters: Start antibiotics as soon as possible, as delay beyond 3 hours significantly increases infection risk 2
• Tetanus prophylaxis: Administer tetanus toxoid if vaccination is not current within 10 years, with Tdap preferred if not previously given 1, 2

Special Considerations for Deer-Related Wounds

• Deep penetrating wounds or those with significant soil contamination may require initial intravenous antibiotics such as ampicillin-sulbactam 1
• Consider enhanced anaerobic coverage (particularly for Clostridium species) if there is significant tissue damage, areas of ischemia, or heavy soil contamination 2
• If MRSA is suspected based on local prevalence or patient risk factors, add trimethoprim-sulfamethoxazole or doxycycline 2

Follow-Up Monitoring

• Assess for signs of infection (increasing pain, redness, swelling, purulent drainage) within 48-72 hours 2
• Extend antibiotic course if signs of infection persist 2
• Evaluate for proper wound healing and need for additional debridement 2