Animal bites are one of the most reported causalities with adults and children. In addition to the emergency measures to stop bleeding in the event of an animal bite, physicians need to look for potential pathogens such as bacteria or virus that can cause further damage to the patient.
Dog and cat bite
It is one of the common forms of animal bites. A dog that attacks or bites has pre-existing tendency of abnormal temperament, which triggers its proactive nature to bite an individual. However, dogs, which are kept as pets that have been vaccinated, are not dangerous when they leave minor scratches with their teeth. Dogs, which are affected by rabies, are more dangerous and can be lethal. An attack by a rabid dog can be traumatizing leading to many physiological and psychological conditions. Immunoglobulin and anti-rabies vaccines are given immediately to the victim to prevent the multiplication of the rabies virus. If ignored, rabies virus can be fatal causing adverse complications such as hydrophobia and sometimes death. Similar approach is taken with respect to cats. In case of cat scratch, immunoglobulin along with antimicrobial such as tetracycline are used to prevent associated bacterial infections caused by Pasteurella and Bartonella species.
Rodent bites are rare but are equivalently dangerous as they are potential carriers of rabies virus along with bacterial species such as Leptospira and streptobacillus SP. In the event of a rodent bite, immediate medical attention is required. The proximity of the bite region to the brain is very significant as it is associated with the rapid propagation the virus.
The most common form of reptile bites is snakebites. These bites are fatal and require immediate medical attention. Snake bites are widely studied and depending upon the type of snake and the potential venom it produces, the anti-venom is administered. Some snakes such as the black mamba and Cobra seen in Africa and Asia produce venom that is neurotoxic. Other snakes such as vipers, rattle snakes and kraits produce venom that is toxic to the circulatory system. Anti-venom administration is followed by patient observation for a period of 24 hours is essential to ensure positive prophylaxis.
In addition, other animals such as raccoons, coyotes, foxes, skunks which fall under the wild mammal categories are also treated with anti-rabies vaccines and tetanus shots.
Management of animal bites
Animal bites have to be effectively analyzed in order to manage them well. The history and the demography of the animal are recorded along with appearance and behavior traits. Evidence-based conclusions are drawn to confirm that the animal especially if it's a mammal is rabid. All wounds have to be cleaned thoroughly to prevent cross infection and sepsis. All puncture wounds ranging from mild to severe have to be treated with respective vaccines and antimicrobial drugs. The most common drugs used are Augmentin, tetracycline, clindamycin and in some cases cefuroxime and metronidazole. This prevents the onset of tissue necrosis by the bacteria. Azithromycin is recommended in case of cat scratch as it prevents the growth of Bartonella.
List of general Antibiotics
Antibiotics are primarily used to treat bacterial infections. They may have secondary uses - treatment of the Syndrome of Inappropriate Antidiuretic Hormone (SIADH) secretion with Declomycin. Some antibiotics are also used to prevent infection (antibiotic prophylaxis) before any surgery or in the case of weakened immune systems. There was a study which indicated that about 300 million prescriptions for antibiotics are issued every year in the US alone and the wide spread use or abuse of the antibiotics is a serious issue. For example, an antibiotic can seriously deplete the normal intestinal micro flora which can result in vaginal yeast infection in susceptible women. Indiscriminate use of antibiotics can bring about increased incidences of Streptococcal disease in children apart from enhanced drug resistance.
Antibiotics Classification: Antibiotics are classified under many categories. Commonly they are grouped based on chemical structure and Antibiotics within the same class exhibit similar kind of effectiveness, allergic potential and toxicity. The exhaustive list below also contains drug allergy or other reactions possible for susceptible individuals as appropriate under each class.
Other types of classification:
Bacterial Spectrum: Broad Spectrum Antibiotics are capable of targeting many types of bacteria while narrow spectrum antibiotics target specifically a single class of bacteria. It is generally preferable to use a specific antibiotic for the specific class of bacteria.
Type of Activity: Bactericidal drugs are intended to kill bacteria while bacteriostatic drugs are intended to inhibit the growth of bacteria.
Broad Spectrum Antibiotics: According to a Swiss Study, this class of Antibiotics which act against Gram+ and Gram- bacteria is prone to misuse. Broad Spectrum Antibiotics - specifically the antipseudomonal agents (i.e. cefepime, ceftazidime, ciprofloxacin, imipenem, meropenem, piperacil lin/tazobactam) plus trovafloxacin were found to be misused.
The following list shows the generic names of common antibiotics prescribed and available under various trade names in the US. We have broadly classified them under the common 'family' names.
Broad Spectrum Penicillins / Amoxicillin : Penicillin Family Antibiotics List
Penicillins - one of the oldest type of broad spectrum antibiotics, share common chemical structure with Cephalopsorins. They are classified as Beta-lactam antibiotics. Aminopenicillins such as Ampicillin and Amoxicillin have extended spectrum of action. Extended Spectrum Penicillins are effective against a broad range of bacteria including Pseudomonas Aeruginosa which affect patients with weakened immune systems.
Allergic reactions are common with Penicillins for susceptible individuals. Cephalosporins can cause seizures or affect the blood clotting time for susceptible patients.
Penicillins and Beta Lactamase Inhibitors
Cephalosporins, one of the largest classes of Antibiotics are used to treat a long list of bacterial infections from around the year 1950. The latest in this class, Ceftaroline is a new fifth generation Cephalosporin - a broad spectrum Antibiotics that shows promise against Gram + bacteria including Methicillin Resistant Staphylococcus Aureus (MRSA),Vancomycin Intermediate S.Aureus (VISA), Vancomycin Resistant S.Aureus (VRSA)and Heteroresistant VISA (hVISA).
Cephalosporin II Generation Antibiotics
Cephalosporin III Generation Antibiotics
Cephalosporin IV Generation Antibiotics
Fourth generation Cephalosporin antibiotics are effective in the treatment of Encephalitis and Meningitis as they cross the blood-brain barrier.
Cephalosporin V Generation Antibioticsor New Generation Cephalosporins - NGCs
The New Generation Cephalosporins show considerable efficacy against a host of bacteria - from MRSA to respiratory pathogens like Streptococcus Pneumoniae, Haemophilus Influenzae and Moraxella Catarrhalis.
β lactam antibacterial resistance: These fifth generation Cephalosporins inhibit the cell wall synthesis of Penicillin Binding Proteins (PBPs). For example, Ceftaroline's anti MRSA efficacy stems from its high affinity for the MRSA associated (Penicillin Binding Proteins)PBP2a. It may have affinity greater than 256 times over other β lactams.
Ceftaroline is effective against the following:
Gram Positive Bacteria which cause skin infections:
Methicillin Resistant Staphylococcus Aureus (MRSA) and resistant isolates
Gram Positive Bacteria which cause Community Acquired Bacterial Pneumonia (CABP):
Staphylococcus aureus(methicillin susceptible isolates)
Gram Negative Bacteria:
Macrolides and Lincosamines
Macrolide Antibiotics have macrocyclic lactone chemical structure. Erythromycin and the newer antibiotics belonging to this broad spectrum class - Azithromycin and Clarithromycin are widely used for their higher level of lung penetration. Erythromycin may rarely result in Myasthenia gravis while Azithromycin may rarely result in Angioedema (Patches of swelling of the skin, mucus membranes and internal organs), Anaphylaxis (hypersensitive reaction due to contact through allergens) or other allergic reactions.
Quinolones and Fluoroquinolones
Fluoroquinolones are synthetically manufactured broad spectrum Antibiotics. Lomefloxacin is reported to cause increased photosensitivity and in some cases may result in convulsion.
Beta lactam Antibiotics: Carbepenems
Aminoglycosides : These antibiotics are specifically used to target aerobic, Gram-negative bacteria. Generally useful against Pseudomonos, Acinetobacter and Enterobacter amongst others. Streptomycin is effective to control tuberculosis causing mycobacteria. Antibiotic treatment with Aminoglycosides often involves the use of another antibiotics for overall better synergetic effect.
Details on Specific Antibiotic Therapy
Gentamicin: Gentamicin is the antibiotic of choice for the treatment of some kind of blood infections caused by gram negative bacilli like the following:
Gentamicin is often used along with beta-lactam antibiotics for better efficiency.
Conventional Dosage: It should be noted that a typical dosage of Gentamicin is usually given 2 to 3 times a day by IV (intravenous) or IM (intramuscular) injections to achieve peak blood concentration between 5.0 μg/mL and 12.0 μg/ml. The dosage mentioned here depends on the type of infection and on other factors like the patient's renal function. Gentamicin is sometimes given at a higher dose than the suggested common dosage - 5-7mg/kg of body weight once per day - termed as pulse dosing for patients with good tolerance and good renal function. Risk of excessive dosage in the case of Gentamicin is Ototoxicity (damage to the inner ear) and Nephrotoxicity (damage to kidneys).
Tetracyclines are not normally prescribed for children under the age of 8 due to the permanent tooth discoloration these drugs cause.
Rifampin also known as Rifampicin (Rifadin)
Many Antibiotics are available for external application on the skin which include:
Topical medications that act as Comedolytics as well as antibiotics:
Recommended Dosage : Antibiotics dosage is based on many factors:
Many antibiotics can be administered parenterally - either through Intravenous (IV) or Intra muscular (IM) injections.
You may find some typical usage instructions, dosage, contra indications and side effects - if any for some of the antibiotics listed above in these pages.
Antibiotics for Anaerobic infections
Anaerobes - the kind of bacteria which can not grow in the presence of oxygen, can infect deep wounds and internal organs - sometimes resulting in gangrene, botulism, tetanus and almost all dental infections.
Some common Anaerobic infections
Many antibiotics do not inhibit/control Anaerobes. But Chloramphenicol, Imipenem, Metronidazole, Clindamycin and Cefoxitin are effective against these bacteria.
New Antibiotics in pipeline: Pseudouridimycin (PUM) is a promising new Antibiotic which inhibits bacterial RNA polymerase (RNAP). What is more, PUM in the research shows its ability to act against drug resistant bacterial pathogens.
The most common side effects of antibiotics are diarrhea, feeling sick and vomiting. Some antibiotics are Teratogens (that can affect the fetus causing birth defects). Some families of antibiotics may have adverse effects on some region : Tetracycline affects bone growth and discolors the teeth. Antibiotics can also induce Dysbiosis (Dysbacteriosis or the condition where the natural flora of the gut are in a state of imbalance).
Some cases of Antibiotics associated enterocolitis can occur after a prolonged treatment with many antibiotics - especially from Clindamycin, Ampicillin, Amoxicillin or any in the Cephalosporin class. The Colitis triggered by the Antibiotics is an inflammation of the intestines caused by the toxins released due to the proliferation of the normally harmless bacterium Clostridium Difficile. In half the cases of antibiotics associated Colitis, it can take the form of a severe Colitis known as Pseudomembranous Enterocolitis where Pseudo membranes (membrane like collections of WBC, mucus and protein) are excreted. Initial symptoms include lower abdominal cramps and diarrhea which can progress to nausea, vomiting, general fatigue, Abdominal pain and very high fever. In severe form, it can cause dehydration, mineral imbalance, low blood pressure, edema in deep skin, toxic megacolon (enlargement of the large intestine) or perforation of the large intestine. This is the reason why additional antibiotics like Vancomycin or Metronidazole are prescribed to control the bacteria - Clostridium Difficile. Additional supplements containing Lactobacillus Acidophilus - the good bacteria that help to reestablish themselves in the intestines - can help.
Antibiotics Toxicity: Some persons develop an allergic reaction to antibiotics such as penicillin and cephalosporin. Others feel sick and experience loss of appetite and bloating and indigestion. Swelling of face and tongue, breathing difficulty and rashes cam become quite serious leading to a life-threatening allergic reaction known as anaphylaxis. Typical side effects of some drugs are listed below:
Penicillin: Penicillins are drugs of choice for many aerobic gram positive infections. Some varieties of penicillin such as ampicillin have effect on gram negative organisms as well. Amino penicillins are administered often as they are broad spectrum antibiotics. Penicillin are often associated with side effects such as allergy, rash, neuro toxicity which includes gangrene and necrosis.
Cephalosporins: Some of the second and third generation cephalosporins are used as broad spectrum antibiotics for the treatment of gram positive and gram negative infections. The drugs administered are cefuroxime, cefotaxime, ceftriaxone, ceftazidime and cefpirome. In many cases cephalosporins induce fever along with thrombocytopenia. Some cephalosporins are not recommended as they are nephrotoxic and have low renal clearance rates.
Aminoglycosides: Aminoglycosides are widely recommended for gram positive and gram-negative infections of the respiratory and urinary tract. Aminoglycosides are administered in many post-operative infections and hospital acquired infections. These drugs are contraindicated during pregnancy as they induce ototoxicity and nephro toxicity. Co-administration of other drugs like diuretics, muscle relaxants, cyclosporin or antifungals can exacerbate toxicities.
Macrolides: Macrolides are a group of broad spectrum antibiotics administered for various infective conditions pertaining to upper respiratory tract and also urinary tract. The drug Azithromycin is safe and widely recommended in pregnancy associated urinary infections. Neuromuscular blockage and rashes have been reported in some cases as side effects of macrolides. The antibiotic Azithromycin from the class of antibiotics - macrolids can cause potentially fatal irregular heart rhythm for some patients as per the recent FDA warning. The risk factor is for those with low levels of Potassium/ Magnesium or those with slower than normal heart rate or it can interfere with some medications to control cardiac arrhythmia or those suffering from the condition - Torsades de pointes , a rare form of Arrhythmia or Cardiac Dysrhythmia (refers to an abnormal rhythm in the heart which results in irregular contraction). However FDA noted that other than Macrolides class of antibiotics, flouroquinolones can also cause QT prolongation for some susceptible patients.
Fluoroquinolones: Fluoroquinolones can induce side effects other than the common ones. These include headache, confusion, dizziness and photo toxicity. Convulsions are noticed in a few cases.
Rifampin which also comes under the name of Rifampicin (Rifadin) is a powerful antibacterial drug prescribed for leprosy, meningitis and tuberculosis. In many cases, this drug is prescribed over a long period and can cause hepatotoxicity if not adequately monitored. This class of drugs imparts red/orange tinge to body fluids. It may potentiate or antagonize the actions of some drugs - thus requiring extreme caution in prescribing other drugs. Even some oral contraceptives may be rendered ineffective when combined with Rifamycin class of antibiotics.
Antibiotic Side Effects
Drug interactions are also not uncommon. Antibiotics can react with herbal or alternate remedies. Some drug combinations are contraindicated, like in the case of penicillin and birth control pills. Penicillin and methotrexate, used in the treatment of cancer and autoimmune diseases is another combination that can produce serious side effects. Cephalosporins are contraindicated with blood thinners. Tetracyclines are contraindicated with retinoids (Vitamin A belongs to this group), blood thinning medications, diuretics, antacids, sucralfate, colestyramine, ergotamine, methysergide and insulin.
Micro organisms evolve resistance to Antibiotics over a period of time resulting in drug resistance. This may occur due to abuse of Antibiotics by the patients or unwarranted prescription of broad spectrum antibiotics or the permeation of antibiotics through consumption of livestock fed with antibiotics for growth promotion or other non therapeutic reasons.
Drug resistance has started soon after the discovery of Penicillin by Sir. Alexander Fleming in 1929. Certain strains of staphylococci developed resistance to Penicillin after some time. Comparatively newer antibiotics introduced in the middle of 20th century barely managed to keep the race against bacteria under control. As the development of antibiotics is becoming more expensive and not remunerative enough for the drug companies, the pace of development of new antibiotics has drastically come down in the recent times.
Usage of Antibiotics should be restricted to therapeutic use alone. Indiscriminate usage of antibiotics can only enhance the drug resistant strains of bacteria which will affect the choice of treatment. It has been noted that about 70 % of bacterial infections in hospitals are resistant to at least one of the antibiotics commonly used to treat such infections.
Resistance to the treatment of life threatening infections caused by a common intestinal bacteria, Klebsiella Pneumoniae, Carbapenem antibiotics has spread to all parts of the world. Klebsiella pneumoniae is a major cause of hospital acquired infections such as pneumonia, bloodstream infections, wound or surgical site infections and meningitis. In many countries, because of drug resistance, Carbapenem antibiotics would not work in more than half of patients treated.
Staphylococcus aureus or commonly called as Staph aureus or MRSA is one of the pathogens which can infect skin,lungs or blood and is one the major drug resistant bacteria.
Methicillin Resistant Staphylococcus Aureus - MRSA is a strain of staphylococcal bacteria resistant to
the antibiotic Methicillin and other antibiotics that normally control staph infections. Now there are 2 variations of MRSA: Hospital Acquired MRSA - HA-MRSA and Community Acquired MRSA - CA-MRSA.
The drug Methicillin was the drug of choice for some time against this pathogen. When Methicillin resistant Staphylococcus Aureus emerged in the hospitals, it was found that many of the infections are resistant to other drugs like - methicillin, tetracycline and erythromycin as well. According to WHO, patients with MRSA are estimated to be 64% more likely to die than people with a non-resistant form of the infection.
Finally the only drug left to control MRSA infection was vancomycin until in 2002, another vancomycin resistant strain (VRSA) appeared. The struggle against such infections continue with newer antibiotics like Daptomycin and Linezolid though some hospitals have reported resistance to these antibiotics too.
Antibiotics interactions with Alcohol :
Many non-prescription medications such as cough syrup, tonics may contain alcohol in their formulation which can result in drug interactions. Alcohol may cause severe reaction when combined with some anti-microbial.
Perhaps the most important alcohol-antibiotic interactions are with the anti protozoal agent belonging to the Nitroimidazole group – Metronidazole or Tinidazole which is used for a variety of infections, including gastrointestinal (like Giardiasis and Amebiasis) and respiratory / Urinary Tract Infections (UTI).
Anti protozoal drugs result in reactions when combined with alcohol. Even the new Nitazoxanide which is relatively free from the bitter metallic taste of the Metronidazole and Tinidazole still can react with alcohol in a reaction called 'disulfiram' which may cause nausea, vomiting, flushing of skin, stomach cramps, headaches, rapid heart rate and difficulty in breathing. A similar reaction can occur with other antibiotics as well.
Alcohol is a depressant of the central nervous system and when combined with antibiotics it can lead to drowsiness, confusion and dizziness. The effects can get serious while driving and in the elderly if the patient is consuming CNS depressant medications such as opioid pain relievers. Alcohol can potentiate the actions of some drugs while limiting the actions of other drugs.
Avoid drinking alcohol completely when the following drugs are taken:( We have even included many older drugs which may no longer be prescribed here)
Be wary of drinking alcohol while taking the following drugs:
Antimicrobial - Alcohol drug interactions
|Metronidazole||disulfiram-like reaction||To avoid combination with alcohol during treatment and for 72 hours after discontinuation of drug|
|Tinidazole||abdominal cramps, nausea, vomiting, headaches, flushing||Avoid combination with alcohol during treatment and for 72 hours after discontinuation drug|
|Cefotetan||flushing, sweating, headache, tachycardia (rapid heart beat)||Avoid combination with alcohol during treatment and for 72 hours after discontinuation of drug|
|Cycloserine||combination may increase risk of central nervous system toxicity; possible seizures||Avoid alcohol while taking drug|
|Ethionamide||combination may increase risk of central nervous system toxicity; possible psychosis||Avoid alcohol while taking drug|
|Isoniazid||increased risk of liver toxicity if daily alcohol consumption||Avoid alcohol while taking drug|
|Linezolid||increased risk of hypertensive crisis (dangerous elevated blood pressure)||Avoid large quantities of drug with beverages|
|Voriconazole (antifungal)||combination with alcohol may either increase or decrease this drug presence due to altered liver metabolism||Avoid this drug with chronic or acute excessive alcohol use|
|Pyrazinamide||combination with alcohol may increase risk for liver toxicity||Use caution while using this drug|
|Thalidomide||combination with alcohol may increase risk for additive sedation, drowsiness, confusion, motor skills; use caution if driving||Avoid alcohol while taking this drug|
|Rifampin||combination with alcohol may increase risk for liver toxicity||Avoid use in alcoholics or with chronic daily alcohol use|
|Didanosine||combination with alcohol may increase risk for Pancreatitis||Avoid use in alcoholics or with chronic daily alcohol use|
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Bibliography / Reference
Collection of Pages - Last revised Date: December 4, 2022