Presumptive therapy for bites and clenched-fist injuries

If presumptive antibiotic therapy is indicated for bite or clenched-fist injury injuries (see Principles of management of bites and clenched-fist injuries), use:

amoxicillin+clavulanate 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally, 12-hourly for 3 days¹. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate oral dosage adjustment. amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate

In the community setting, if there is likely to be a delay in accessing oral therapy, give an immediate dose of intramuscular procaine benzylpenicillin. Use:

procaine benzylpenicillin 1.5 g (child: 50 mg/kg up to 1.5 g) intramuscularly, as a single dose while awaiting oral therapy². For dosage adjustment in adults with kidney impairment, see procaine benzylpenicillin dosage adjustment. procaine benzylpenicillin procaine benzylpenicillin procaine benzylpenicillin

Start continuation therapy with oral amoxicillin+clavulanate (see dosage above) as soon as it is available.

If oral absorption is likely to be impaired (eg following major trauma), use intravenous therapy:

amoxicillin+clavulanate intravenously amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate

2+0.2 g formulation

adult, or child 40 kg or more: 2+0.2 g 8-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate intravenous dosage adjustment

OR

1+0.2 g formulation

adult, or child 40 kg or more: 1+0.2 g 6-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate intravenous dosage adjustment

child 1 month to younger than 3 months and less than 4 kg: 25+5 mg/kg 12-hourly

child 1 month to younger than 3 months and 4 kg or more: 25+5 mg/kg 8-hourly

child 3 months or older and less than 40 kg: 25+5 mg/kg up to 1+0.2 g 8-hourly.

Switch to oral amoxicillin+clavulanate (see dosage above) as soon as oral absorption is adequate and oral therapy is tolerated.

For patients with hypersensitivity to penicillins, or at increased risk of methicillin-resistant Staphylococcus aureus (MRSA) infection (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), for whom oral therapy is indicated, use:

metronidazole 400 mg (child: 10 mg/kg up to 400 mg) orally, 12-hourly for 3 days metronidazole metronidazole metronidazole

PLUS EITHER

1doxycycline orally, 12-hourly for 3 days³ doxycycline doxycycline doxycycline

adult: 100 mg

child less than 21 kg: 2.2 mg/kg⁴

child 21 to less than 26 kg: 50 mg

child 26 to 35 kg: 75 mg

child more than 35 kg: 100 mg

OR

2trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or older: 4+20 mg/kg up to 160+800 mg) orally, 12-hourly for 3 days. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment. trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole

For patients who report hypersensitivity to a penicillin who require intravenous or intramuscular therapy, seek expert advice.

¹ Amoxicillin+clavulanate may be suitable for children aged 1 month to younger than 2 months, but a different dosage is required.Return

² Procaine benzylpenicillin was discontinued in Australia in December 2022Return

³ An oral liquid formulation of doxycycline is not marketed in Australia but is available via the Special Access Scheme. For formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return

⁴ When used short term (eg less than 21 days), doxycycline has not been associated with tooth discolouration, enamel hypoplasia or bone deposition so can be used in children of all ages.Return