A 32-year-old previously healthy man presents with fevers and hypotension. He was bitten by a dog 4 days ago with deep puncture wounds that required operative closure. He has a history of anaphylaxis to penicillin and cephalosporins and has been receiving trimethoprim-sulfamethoxazole since surgery. Tetanus toxoid was administered and his other immunizations are up to date. On examination, his wound shows evidence of cellulitis.
Which of the following changes to his antibiotic regimen is most appropriate?
A. Change trimethoprim-sulfamethoxazole to levofloxacinCorrect Answer: C
Prophylactic antibiotics are not typically required after animal bites. However, they reduce the rate of infection of high-risk bites:
Amoxicillin-clavulanate for 3 to 5 days is the preferred prophylactic agent. Alternatives in patients with cephalosporin allergies should have activity against both Pasteurella multocida (ie, trimethoprim-sulfamethoxazole, doxycycline, levofloxacin) and anaerobes (clindamycin, metronidazole). Thus, this patient has untreated anaerobic infection and would benefit from the addition of clindamycin. Changing to levofloxacin or adding vancomycin would not give the appropriate coverage. Tetanus toxoid should also be administered to all patients who have completed primary immunization but who’s booster has been 5 years of greater.
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