Trip Answers

Question answered:24/07/07 Warning! this question is over two years old.

The Clinical Knowledge Summaries (CKS) topic review on insect bites and stings provides information on managing different levels of reaction to insect and sting bites but there is no mention of antibiotics for any sub-group including diabetics. [2]

 

However in the CKS laceration topic review it states, “Antibiotic prophylaxis is not usually required for simple lacerations”, but lists certain groups/situation where antibiotic prophylaxis may be appropriate;

 

 - “For wounds to the feet, extensive intraoral lacerations, or stellate lesions: consider flucloxacillin (or erythromycin if the person is allergic to penicillin)
 - For lacerations that are contaminated with soil, manure, or faeces; puncture wounds; or lacerations that have a significant degree of devitalized tissue: consider co-amoxiclav, or erythromycin plus metronidazole (if penicillin-allergic).
 - For people with diabetes mellitus; alcohol dependency; peripheral vascular disease; asplenism; or immunosuppression, including those on oral corticosteroids or chemotherapy: consider flucloxacillin or (or erythromycin if the person is allergic to penicillin). For contaminated wounds (see above), puncture wounds, or wounds that have a significant degree of devitalized tissue, consider co-amoxiclav (or erythromycin plus metronidazole if the person is allergic to penicillin).”[3]

 

The CKS topic review on human and animal bites states that a 7-day course of oral antibiotics should be given to certain groups of individual which includes;

 

“People with high-risk animal bite wounds, such as hand, foot, and facial injuries; puncture wounds; wounds requiring surgical debridement; wounds involving joints, tendons, ligaments, or suspected fractures.

 

People who are at risk of serious wound infection complications (e.g. those who are diabetic, post mastectomy, cirrhotic, asplenic, or immunosuppressed).”[2]

 

The Health Protection Agency also has recommendations regarding the use of/duration of prophylaxis antibiotics from animal/human bites:

 

“Antibiotic prophylaxis following animal bites should be employed selectively, being reserved for the bites most likely to become infected (cat, human) where inadequate debridement cannot be achieved, and in immunocompromised patients at high risk of infection

 

High-risk patients with more justification for antibiotic prophylaxis include those with previous mastectomy, prosthetic joints, diabetes, immunosuppression, cirrhosis, steroid therapy, and splenectomy.

 

Prophylaxis should be given for a total of 5 days.

 

Parenteral antibiotics such as co-amoxyclav plus ciprofloxacin, or imipenem plus clindamycin are necessary when rapidly spreading cellulitis, signs of sepsis or involvement of bone or joint is likely.

 

Ten days therapy for established cellulitis or localized abscesses is the norm, with 3 weeks for tenosynovitis and 6 weeks for osteomyelitis. In practice, intravenous therapy until the CRP falls to about 40 mg/L is an objective guide of when to change to oral antibiotics.”[4]

 

References
1) Clinical Knowledge Summaries. Topic Review.  Bites – human and animal.  SCHIN LTD. [Accessed: 23/07/07]
http://cks.library.nhs.uk/Bites_human_and_animal/In_depth/Management_issues
2) Clinical Knowledge Summaries. Topic Review.  Insect bites and stings. SCHIN LTD. [Accessed: 23/07/07]
http://cks.library.nhs.uk/insect_bites_and_stings/in_depth/management_issues
3) Clinical Knowledge Summaries. Topic Review.  Lacerations. SCHIN LTD. [Accessed: 23/07/07]
http://cks.library.nhs.uk/Lacerations/In_depth/Management_issues
4) HPA (2006c) Animal bites and Pasteurella multocida: information for Healthcare Staff. Health Protection Agency. [Accessed: 23/07/2007].
http://www.hpa.org.uk/infections/topics_az/zoonoses/pasteurella/healthcare_info.htm
Other information of interest from the TRIP database:
Mansingh A and Sawh D. Hand infections in  Jamaica. West Indian Med J. 2001 Dec;50(4):309-12. (http://www.hubmed.org/display.cgi?issn=00433144&uids=11993023).

 

---

DISCLAIMER: TRIPanswers is a collection of clinical questions and answers.  Each provider will have their own methodology in answering questions and these are likely not to be as rigorous as systematic review.  If you have any doubt as to the implications of this contact the Q&A Service Provider for further information. This document is presented for information purposes only. This document cannot and should not be used as a basis of diagnosis or choice of treatment, and is in no way intended to replace professional medical care or attention by a qualified practitioner. TRIPanswers and TRIP Database Ltd are not responsible or liable for, directly or indirectly, ANY form of damage whatsoever resulting from the use/misuse of information contained in or implied by this document.  Also, ensure you have read the terms and conditions for using the site.