Pediatric emergency medicine trisk 2033 2033
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The following wounds may be considered at high risk for infection: puncture
wounds, hand or foot wounds, wounds provided initial care after 12 hours, cat or
human bites, and wounds in immunosuppressed patients. As a general rule, these
wounds should not be sutured. The use of prophylactic antibiotics is
recommended, but controversial. Suggested indications for antibiotics include the
following:
Human and cat bites through dermis
Bites closed prematurely
Bites more than 8 hours old with significant crush injury or edema
Potential damage to bones, joints, or tendons
Bites to hands and feet
Patients with increased risk of infection
Signs of infection within 24 hours
No single antibiotic is ideal for all the most common organisms involved in
infected mammalian bite wounds. Amoxicillin-clavulanic acid (Augmentin) (30
to 50 mg/kg/day) is effective for P. multocida, Streptococcus, and anaerobes, as
well as in providing methicillin-susceptible S. aureus (MSSA) coverage.
Combination therapy with phenoxymethyl penicillin (penicillin VK) and
cephalexin or dicloxacillin has been suggested by some. An extended-spectrum
cephalosporin or trimethoprim-sulfamethoxazole PLUS clindamycin is an
alternative for the penicillin-allergic patient. The initial dose of antibiotic should
be given in the ED and continued for the next 3 to 5 days. It must be emphasized
that local care ultimately prevents infection more effectively than prophylactic
antibiotics. Studies indicate that prophylactic oral antibiotics for low-risk dog bite
wounds are not indicated because the differences in the rate of infection are not
significant, and the cost–benefit ratio is not worth the risk of allergic reaction.
Moderate to severe hand infections or other wounds that involve deep
structures usually require debridement and exploration under general anesthesia.
Aerobic and anaerobic culture swabs should sample the depth of the wound; or, in
cases of cellulitis, the specimen can be collected by needle aspiration of the
leading edge of erythema. While awaiting cultures, a Gram stain is often helpful
in differentiating the probability of staphylococci or streptococci from P.
multocida.
Parenteral antibiotics and admission to the hospital are indicated if the child
has systemic symptoms/signs or has wounds with potential functional or cosmetic
morbidity. The choice of parenteral antibiotics should be governed by the same
