外科の先生より「犬の咬傷」の予防抗菌薬について、ご相談をいただきました。
原因微生物
The predominant organisms in animal bite wounds are the oral flora of the biting animal (notable pathogens includePasteurella, Capnocytophaga, and anaerobes) as well as human skin flora (such as staphylococci and streptococci).
予防抗菌薬
infection in patients given antibiotics compared with controls
RR 0.56 (95% confidence interval, 0.38 to 0.82).
という訳で、抗菌薬は必要そうです。
Up To Dateより引用
| Antibiotic agents | Adults | Children |
| Agent of choice | ||
| Amoxicillin-clavulanate | 875/125 mg twice daily | 20 mg/kg per dose (amoxicillin component) two times daily (maximum 875 mg amoxicillin and 125 mg clavulinic acid per dose)¶ |
| Alternate empiric regimens include: | ||
| One of the following agents with activity against P. multocida: | ||
| Doxycycline* | 100 mg twice daily | Not recommended in children <8 years of age |
| TMP-SMX* | 1 double strength tablet twice daily | 4 to 5 mg/kg (trimethoprim component) per dose twice daily (maximum 160 mg trimethoprim per dose) |
| Penicillin VK | 500 mg four times daily | 12.5 mg/kg per dose four times daily (maximum 500 mg per dose) |
| Cefuroxime | 500 mg twice daily | 10 mg/kg per dose twice daily (maximum 500 mg per dose) |
| Moxifloxacin | 400 mg once daily | Use with caution in children <18 years of age |
| PLUS | ||
| One of the following agents with anaerobic activity: | ||
| Metronidazole | 500 mg three times daily | 10 mg/kg per dose three times daily (maximum 500 mg per dose) |
| Clindamycin* | 450 mg three times daily | 10 mg/kg per dose three times daily (maximum 450 mg per dose) |
| The following agents have poor activity against P. multocida and should be avoided: | ||
| Cephalexin | ||
| Dicloxacillin | ||
| Erythromycin | ||
よって、「Amoxicillin-clavulanateを3〜5日」を提案しました。
オーグメンチン250では不安があるので、
岩田健太郎先生の本を参考に サワシリン250を2cap追加し
Amoxicillin750-clavulanate125 としました。
なお、以下のガイドライン recommendations 40から、投与期間を3〜5日としました。