Resident Manual of Trauma to the Face, Head and Neck

Chapter 9: Soft Tissue Injuries of the Face, Head, and Neck

y y Use amoxicillin + clavulanate (Augmentin®) as a first-line treatment. y y If the patient is allergic to penicillin derivatives, consider: •• In adults, a tetracycline (e.g., doxycycline), or combination therapy with clindamycin and a fluoroquinolone. •• In children, a macrolide (e.g., erythromycin) or combination therapy with trimethoprim + sulfamethoxazole (Bactrim™) and clindamycin. 6. Human Bites y y Use antibiotic prophylaxis if wounding is deeper than the epidermis, as human flora contains an abundance of bacterial pathogens. y y Cover Eiknella corrodens (not covered typically by first-generation cephalosporin or clindamycin alone). y y Use amoxicillin + clavulanate (Augmentin®), as a first-line treatment. y y If the patient is allergic to penicillin derivatives, consider combination therapy with clindamycin plus trimethoprim + sulfamethoxazole (Bactrim™), or a fluoroquinolone therapy with clindamycin plus trimethoprim + sulfamethoxazole (Bactrim™), or a fluoroquinolone (e.g., ciprofloxicin). B. Pros and Cons of Topical Antibiotics Numerous alternatives exist to include various combinations, such as bacitracin, neomycin, polymyxin B (Neosporin®), bacitracin + poly- myxin B (Polysporin™), or triple antibiotic ointment. These topical antibiotics allow for high drug concentrations at the site of injury, while limiting systemic toxicity. They also increase moisturization, and thus improve the rate of reepithelization. Strong data clearly delineating reduction in infection rates are lacking for continued utilization beyond clinical closure of the epithelium. Once superficial wound healing is complete (24–48 hours), there is minimal penetration into deeper tissues that would actually prevent cellulitic infection. 1. Neomycin y y Active against most gram-negative bacteria and a few gram-positive bacteria, but inactive against anaerobes as well as streptococci. y y Cost-effective. y y High likelihood of contact dermatitis (some reports indicate ~15 percent of patients). 2. Bacitracin y y Most effective against gram-positive bacteria, not to include methicil- lin-resistant Staphylococcus aureus (MRSA).

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Resident Manual of Trauma to the Face, Head, and Neck