9. Antibiotic Prophylaxis in the ED and ICU

Mammalian bites

General bite wound management

• non-pharmacological management

• Tetanus prophylaxis

Mammalian bites

• polymicrobial infections

Risk factors for infection

• high risk bites

• patient factors

Antibiotic selection

Rabies - burden of disease

Rabies - Exposure

Rabies - Management

• non-pharmacologic

• 2 others

Rabies vaccine and immune globulin schedule

Rabies vaccine and Rabies immune globulin (RIG) Administration

• What does the case tell us:

  • Pt bitten by neighbor’s dog - dog is most likely vaccinated and does not have rabies b/c it is a pet

    • So pt is not indicated for a rabies immunoglobulin shot or rabies vaccine

  • Bite is deep and bleeding

    • water + soap + virucidal agents to properly disinfect and clean wound

    • give augmentin 875/125 mg PO BID x 3-5 days

  • Does not recall last Tdap shot

    • administer Tdap shot

Open fracture

• definition

• concern

• Classification for open fractures

Open fracture antibiotic prophylaxis

• grade I and II

• grade III

Open fracture antibiotic prophylaxis

• soil or fecal contamination

• water contamination

• severe, documented beta-lactam allergy

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