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Amoxicillin-clavulanate
31%
26/84
Clindamycin and ciprofloxacin
40%
34/84
Penicillin
2%
2/84
Piperacillin-tazobactam
7%
6/84
Trimethoprim-sulfamethoxazole
17%
14/84
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This patient is presenting after a cat bite, which warrants antibiotic treatment with clindamycin and ciprofloxacin given this patient's Stevens-Johnson syndrome reaction to cephalosporins. Cat/dog bites typically become infected (with cat >> dog) thus warranting antibiotic treatment. Any patient presenting after an animal bite should have the would irrigated vigorously. A tetanus vaccine should be administered, and the patient should be given rabies prophylaxis if there is any concern for rabies (such as an unprovoked bite in a wild animal). Ultimately, patients should be discharged with amoxicillin-clavulanate to cover for Pasteurella, Streptococcus, and Staphylococcus species. Second-line agents that the patient could take if allergic to amoxicillin-clavulanate include doxycycline and clindamycin in combination with ciprofloxacin or trimethoprim-sulfamethoxazole. Incorrect Answers: Answer 1: Amoxicillin-clavulanate would be the first-line antibiotic for a human or animal bite; however, it would not be given to a patient with a severe reaction to a cephalosporin (despite the low cross-reactivity) when there are suitable alternatives. Anaphylaxis and Stevens-Johnson syndrome are severe complications that would warrant a different antibiotic class. Answer 3: Penicillin would be insufficient coverage for an animal bite, but could be used for conditions such as streptococcal pharyngitis, which would present with a sore throat, palatal petechiae, and a fever. Answer 4: Piperacillin-tazobactam is too aggressive/broad an antibiotic for a simple cat bite. It would be indicated in sepsis/septic shock and has excellent coverage for gram positives, gram negatives, and Pseudomonas aeruginosa. Answer 5: Trimethoprim-sulfamethoxazole would be an appropriate regimen for treating a cat/dog bite together with clindamycin but is insufficient coverage by itself. Bullet Summary: Clindamycin and ciprofloxacin is an appropriate treatment regimen for a cat/dog bite in a patient who cannot tolerate amoxicillin-clavulanate.
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