Empirical therapy for localised bite and clenched-fist injury infections

For empirical therapy of localised bite or clenched-fist injury infection not associated with systemic features or involving deeper tissues (such as bones, joints or tendons), 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 5 days¹. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate oral dosage adjustment. A longer duration of treatment may be required depending on clinical response. amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate

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), use:

1metronidazole 400 mg (child: 10 mg/kg up to 400 mg) orally, 12-hourly for 5 days. A longer duration of treatment may be required depending on clinical response metronidazole metronidazole metronidazole

PLUS EITHER

1doxycycline orally, 12-hourly for 5 days. A longer duration of treatment may be required depending on clinical response² doxycycline doxycycline doxycycline

adult: 100 mg

child less than 21 kg: 2.2 mg/kg³

child 21 to less than 26 kg: 50 mg

child 26 to 35 kg: 75 mg

child more than 35 kg: 100 mg

2trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or older: 4+20 mg/kg up to 160+800 mg) orally, 12-hourly for 5 days. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment. A longer duration of treatment may be required depending on clinical response trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole

OR THE COMBINATION OF

2ciprofloxacin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 12-hourly for 5 days⁴ ⁵. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment. A longer duration of treatment may be required depending on clinical response ciprofloxacin ciprofloxacin ciprofloxacin

PLUS

clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally, 8-hourly for 5 days⁶. A longer duration of treatment may be required depending on clinical response. clindamycin clindamycin clindamycin

Modify therapy based on the results of Gram stain, culture and susceptibility testing.

If infection progresses despite antibiotic therapy, seek expert advice; surgical consultation or intravenous therapy may be required.

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

² 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

³ 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

⁴ Ciprofloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, there are few data from human trials to support this finding. Ciprofloxacin can be used in children when it is the drug of choice.Return

⁵ An oral liquid formulation of ciprofloxacin is not commercially available; for formulation options for children or people with swallowing difficulties, see the Don't Rush to Crush Handbook, published by the Society of Hospital Pharmacists of Australia [URL].Return

⁶ An oral liquid formulation of clindamycin is not commercially available; for formulation options for children or people with swallowing difficulties, see the Don't Rush to Crush Handbook, published by the Society of Hospital Pharmacists of Australia [URL].Return