SKIN - Bite Wound - Dog Bite (Pasteurella multocida, P. canis, Viridans streptococci, Staphylococcus aureus, anaerobes) Give tetanus prophylaxis. Evaluate need for rabies prophylaxis. Outpatient management with oral antimicrobial therapy may be appropriate for early, minor, wounds. Many patients, especially those with bite to the hand, face, or groin may require hospitalization and surgical (orthopaedic) consultation.
Amoxicillin/clavulanate (Augmentin^®) Pregnancy: B; Lactation: Unk Q12H Formulations: Tabs: 500 mg/125 mg, 875 mg/125 mg Chewable Tabs: 200 mg/28.5 mg, 400 mg/57 mg Oral Susp: 200 mg/28.5 mg/5 mL, 400 mg/57 mg/5 mL	Children: 40-45 mg amoxicillin component/kg/day (max 1600 mg/day) in divided doses two or three times daily; reevaluate in 3-5 days to determine need for debridement and duration of therapy. Q12H using 200 mg/5 mL susp @ 45 mg/kg/day 9 kg (20 lb) = 1 tsp (5 mL) Q12H 13 kg (29 lb) = 1½ tsp (7.5 mL) Q12H 18 kg (40 lb) = 2 tsp (10 mL) Q12H Q12H using 400 mg/5 mL susp @ 45 mg/kg/day 18 kg (40 lb) = 1 tsp (5 mL) Q12H 27 kg (59 lb) = 1½ tsp (7.5 mL) Q12H 35 kg (77 lb) = 2 tsp (10 mL) Q12H >40 kg = Use adult dose (max 875 mg Q12H). Adult: 500-875 mg twice daily for 3-5 days.		Food: Take with food to reduce diarrhea. Important side effects: Diarrhea (common), nausea, rash. Use cautiously in hepatic disease.
			Reduce dose in renal disease (CrCl <30 mL/min).
Clindamycin An alternative for patients with beta-lactam intolerance. (Cleocin^® Generics available Pregnancy: B; Lactation: Unk Caps: 75 mg, 150 mg, 300 mg Oral Solution: 75 mg/5 mL Must administer clindamycin with a fluoroquinolone (adults) or trimethoprim/sulfamethoxazole (children).	Children: 10-20 mg/kg/day (max 1200 mg/day) in divided doses three or four times daily for 3-5 days. 75 mg/5 mL @ 10 mg/kg/day divided Q8H 10 kg (22 lb) = ½ tsp (2.5 mL) Q8H 20 kg (44 lb) = 1 tsp (5 mL) Q8H 30 kg (66 lb) = 1½ tsp (2.5 mL) (7.5 mL) Q8H 40 kg (88 lb) = 2 tsp (10 mL) Q8H 50 kg (110 lb) = 300 mg PO Q8H		Food: May take with or without meals. Take with full glass of water to prevent esophagitis. Important side effects: Diarrhea (may be severe), nausea.
	≥60 kg and Adult: 300 mg PO four times daily for 3-5 days.
Ciprofloxacin (Cipro^®) Pregnancy: C; Lactation: Unsafe Tabs: 250 mg, 500 mg, 750 mg     Use fluoroquinolone in conjunction with clindamycin in adults with beta-lactam intolerance.	≥18 years: 500 mg PO twice daily for 3-5 days.	Food: Take on empty stomach 1 hour before or 2 hours after a meal. May take with food if it causes GI upset, but avoid large amounts of dairy products. May take 2 hours before or 6 hours after sucralfate, antacids, aluminum, magnesium, calcium, zinc, iron, vitamins, or mineral supplements. Important side effects: Photosensitivity, dizziness. Reduce dose in renal disease (CrCl <50 mL/min).
Trimethoprim/Sulfamethoxazole (Bactrim^®, Septra^®) Generics available Pregnancy: C; Lactation: Unsafe Single Strength (SS) Tabs: 80 mg/400 mg Double Strength (DS) Tabs: 160 mg/800 mg Oral Susp: 40 mg/200 mg per 5 mL Use in conjunction with clindamycin in persons with beta-lactam intolerance.	Children ≥2 months: 6-12 mg/kg/day TMP component (max 320 mg/day) in divided doses twice daily for 3-5 days. 40 mg/200 mg/5 mL 10 kg (22 lb) = 1 tsp (5 mL) Q12H 20 kg (44 lb) = 2 tsp (10 mL) or 1 SS Tab Q12H 30 kg (66 lb) = 3 tsp (15 mL) or 1½ SS Tab Q12H 40 kg (88 lb) = 4 tsp (20 mL) or 2 SS Tabs or 1 DS Tab Q12H for 10 days. Adult: 1 DS tablet PO twice daily for 3-5 days.	Food: May take without regard to food. Encourage fluids. Important side effects: Photosensitivity, rash. Reduce dose in renal disease (CrCl <30 mL/min).