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