A 40-yr-old man presents with a swollen erythematous finger and right axillary tenderness, 24 hours after being bitten by his pet dog. What is the best Rx?
A. Metronidazole
B. Aciclovir
C. Fluconazole
D. Flucloxacillin
E. Co-amoxiclav
Answer:
E--Co-amoxiclav
DIscussion: Dog bites become infected in 10% of cases. The commonest organisms are anaerobic mouth flora and Pasteurella multocida. Other organisms include Capnocytophaga spp and Streptococcus pyogenes.
Co-amoxiclav, (a mixture of amoxicillin and clavulinic acid) is appropriate as it is effective against all the most likely organisms.
HSV infection is most unusual in cases of dog bites, though monkey bites often transmit this virus.
Although dogs harbour fungal infections including Blastomyces,Microsporidium and Trichosporon spp, these are dermatophytes and only produce superficial skin rashes, and therefore the antifungal agent fluconazole, is not indicated in this Pt.
Flucloxacillin is not active against anaerobic bacteria.
Metronidazole, a good antibiotic against anaerobic bacteria, but does not cover aerobic Gram negative organisms.
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