Exposure to Goose Feces: No Routine Antibiotic Prophylaxis Indicated
Routine antibiotic prophylaxis is not recommended for simple exposure to goose feces without evidence of infection or high-risk wound contamination.
When Antibiotics Are NOT Needed
Simple environmental exposure (stepping in, touching, or incidental contact with goose droppings) does not warrant antibiotic therapy, as the risk of bacterial infection from fecal contact alone is extremely low without a breach in skin integrity 1
Intact skin provides an effective barrier against bacterial pathogens commonly found in waterfowl feces, including Salmonella, Campylobacter, and E. coli species 1
Hand washing with soap and water is the primary intervention for fecal exposure without wounds 1
When Antibiotics ARE Indicated
For Contaminated Wounds or Bites
If goose feces contaminated an open wound or if a goose bite occurred with fecal exposure, treatment follows bite wound protocols:
First-line therapy: Amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days provides optimal coverage against polymicrobial flora including aerobic and anaerobic bacteria 2, 3, 4
For penicillin allergy: Doxycycline 100 mg twice daily is the preferred alternative, though it has limited activity against some streptococci 2, 3
Severe infections requiring hospitalization: Ampicillin-sulbactam 1.5-3.0 g IV every 6-8 hours 2, 4
For Gastroenteritis Symptoms
If diarrheal illness develops after exposure (typically 12-72 hours post-exposure):
Campylobacter infection (most common from waterfowl): Azithromycin 500 mg once daily for 3 days is superior to fluoroquinolones due to widespread ciprofloxacin resistance 5
Salmonella gastroenteritis: Antibiotics are NOT routinely recommended for immunocompetent patients, as treatment may prolong fecal shedding 1
Exceptions requiring treatment: Patients <6 months or >50 years old, immunocompromised status, prosthetic devices, or severe illness warrant ciprofloxacin 500 mg twice daily for 5-7 days (if susceptible) or azithromycin 1, 6
Critical Pitfalls to Avoid
Do not prescribe antibiotics for asymptomatic fecal exposure - this promotes resistance without clinical benefit 1
Avoid fluoroquinolones as first-line for suspected Campylobacter - resistance rates exceed 50% in many regions, making azithromycin the superior choice 5
Do not use antimotility agents (loperamide, diphenoxylate) if bloody diarrhea or high fever develops, as this increases risk of complications with enterohemorrhagic E. coli 1
Adjunctive Measures
Immediate wound care: Thorough irrigation with sterile saline for any contaminated wounds 2, 3
Tetanus prophylaxis: Update if not current within 10 years for any wound contamination 2, 3
Hydration: Oral rehydration is the cornerstone of gastroenteritis management regardless of antibiotic use 1
Special Populations
Immunocompromised patients: Lower threshold for antibiotic treatment of gastroenteritis (TMP-SMZ or fluoroquinolones for 14 days or longer if relapsing) 1
Pregnant women: Treat Salmonella gastroenteritis to prevent extraintestinal spread; use ampicillin, cefotaxime, ceftriaxone, or TMP-SMZ (avoid fluoroquinolones) 1
Children <3 months: Treat any Salmonella gastroenteritis to prevent bacteremia; options include TMP-SMZ, ampicillin, cefotaxime, or ceftriaxone 1