just like UW QS>>>>>... - a_antibody

[ArchivalUser]

A 6-year-old girl is brought to the emergency department 10 hours after being bitten on her face while
she was playing "dog" with her friend. The two girls were on the ground with the family dog, laughing,
growling, and "biting the air," when all of a sudden the patient felt a "sharp, stabbing pain" on her right
check. She ran to the mirror and started screaming when she saw blood on her face. "It all happened so
fast" that nobody is exactly sure what happened. Both the friend and the dog had blood on their mouths,
but they are unsure if it was the girl or the dog who actually broke the patient's skin. The dog and both
girls are up-to-date with all vaccinations. Physical examination shows a 2-cm laceration on her right
check. The surrounding tissue is tender. You request a plastic surgery consult after culturing and
copiously irrigating the wound. The most appropriate additional treatment is to


  A. administer ampicillin/sulbactam, intravenously

  B. administer metronidazole, intravenously

  C. give her clindamycin, orally

  D. give her penicillin V, orally

  E. provide no antibiotic therapy at this time

[ArchivalUser]

I would give oral ampicillin/sulbactam.....but from the choices given...i would go for aaaaaaaaaa

[ArchivalUser]

aaa

[ArchivalUser]

ccc

[ArchivalUser]

Explanation:

The correct answer is A. This patient has a bite wound on her face that was either caused by a dog
or another human, and she requires antibiotic prophylaxis. The most appropriate of all of the choices is
ampicillin/sulbactam, intravenously because it covers the most likely pathogens such as S. aureus, P.
multocida, H. influenzae, and B-lactamase-positive oral anaerobes. This girl requires treatment
because all human bites require antibiotics, and dog bites to the face typically require treatment.

Metronidazole (choice B) is not the preferred antibiotic prophylaxis for human or dog bites. It is given
for anaerobic infections, giardiasis, trichomonas, pseudomembranous colitis, and bacterial vaginosis.

Clindamycin (choice C) may be given to cover Gram-positive cocci and anaerobes. However, it is
best given along with trimethoprim-sulfamethoxazole to cover the other potential pathogens. However,
this is not the preferred antibiotic regimen. Since there is a chance that she will be admitted to the
hospital and because it is a facial wound that might have been inflicted by another person, an
intravenous route of administration is best (even if it is one dose in the emergency department and
then the patient is discharged with a prescription for oral therapy).

Penicillin V, orally (choice D) is not the preferred antibiotic prophylaxis for human or dog bites
because of poor coverage of some anaerobes and Gram-negative organisms, and most of the
Gram-positive organisms present in human or dog bite infections. Penicillin V is typically used to treat
streptococcal infections.

No antibiotic therapy is indicated (choice E) in non-extensive dog bites that do not appear infected,
do not occur on the face or involve a bone or joint, and when there are no co-morbidities. Human bites
always require antibiotics and often require hospital admission. Since they are unsure as to the source
of the bite, and it involved the face, antibiotics are indicated.