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amoxicillin-clavulanate, a 2nd or 3rd generation cephalosporin, a quinolone, a
penicillinase resistant penicillin, or a tetracycline antibiotic (erythromycin is not an
acceptable alternative). Wild cats, like their domestic counterparts, inflict bite wounds
contaminated with Pasteurella multocida, and antibiotic selection should include
coverage for this pathogen. Update tetanus immunization as these injuries are high-risk
wounds for tetanus.
IV. RABIES
A rabies exposure consists of a bite, contamination of an open wound or abrasion with
saliva, or contact with any mucous membrane by saliva from an infected animal.
However, in the United States, because rabies is universally lethal in humans,
postexposure prophylaxis currently is often given following any contact--sometimes just
close proximity--with a rabid animal. The possibility of rabies should be considered
following a bite by a previously vaccinated dog or cat if the attack was unprovoked--a
bite is not considered provoked if an attempt were being made to feed, pet, run by, or
capture the animal--or if the animal was acting unnaturally prior to the bite.
Bites by livestock (cattle, sheep, horses) have the potential to cause rabies, although they
almost never do in the United States. Consultation with a veterinarian following a bite
appears advisable. Rodents and lagomorphs almost never transmit rabies to humans even
though these animals, like all mammals, are susceptible to rabies. Mice and rats are used
for laboratory studies.
CDC advises that anyone bitten by any wild animal should receive rabies postexposure
prophylaxis unless the animal is captured and examined for rabies.
Since 1980 all but four of the approximately thirty human rabies infections acquired in
the United States have come from bats. Current recommendations to avoid bat rabies are:
·
Dwellings should be "bat-proofed;"
·
Any skin contact with bats should be assiduously avoided;
·
Any person who has contact with a bat, regardless of whether a bite is thought to
have occurred, should receive postexposure prophylaxis unless the bat can be examined
for rabies;
·
Any person who has slept in a room in which a bat is found, particularly a child,
should receive postexposure prophylaxis unless the bat is caught and examined for rabies.
Rabies therapy is a race to produce immunity before clinical signs of infection appear.
Postexposure therapy consists of:
·
Thorough cleansing of the wound to reduce the viral inoculum;
·
Administration of rabies immune globulin, as much as possible around the
wound;
