Management of infection after cat and dog bites – rational use of antibiotics?

Problem

How are guidelines concerning treatment of cat and dog bites are followed? Is the use of antibiotics rational?

Approach

As a starting point we used a compilation of the current guidelines for treatment.Calculation of sample size was based on the hypothesis that one must find 75% adherence to treatment guidelines. With 70 medical record audits, this gives a 95% confidence interval of ± 10% which is considered to be narrow enough.Data was collected from the health center's medical record data. Cases were identified with the keywords "cat / dog" and "bite / bitten".Anonymised data on age, sex, infection symptoms, general symptoms, antibiotic and possible risk factors were recorded. To calibrate the study's analysts the main researcher and an independent colleague assessed the first ten journals separately. Their results were consistent. The treatment of antibiotics could not be registered in detail as the former electronic patient record that we used was closed down in 2015 and the old recipes no longer open and readable. Age over 50 years, compromised immunity, pregnancy, severe hepatic disease, asplenia, and prayed near the point or of the face was assessed as a risk factors according to the guidelines and enrolled in the study. Each patient was assessed in relation to the recommendation that was current the investigation year.

Findings

The guidelines are followed correctly in 68.6% of all dog and cat bite cases, in 30% deficient and unclear in 1.4% At deficient adherence the doctor in 10% of the cases chose effective, but too broad spectrum of antibiotics, and in 12.9% antibiotic treatment that did not work according to guidelines. In one case, the patient received no antibiotics despite strong indication and in four cases; patients received unnecessarily antibiotics, "just in case".

Consequences

This is a study from a large primary health care center in the region of Västra Götaland. Conclusions can not be drawn concerning all health care centers but the study gives an indication of what it might be lika at other health care centers in the region.Annual updating of guidelines and recommendations for rational use of antibiotics concerning cat and dog bites is essential.Unlike other soft-tissue infections heracillin, clindamycin and cephalosporins are not effective against dog and cat bite infections. This should be emphasized in updating the information as it might also be valid for other health care centers.Rational use of antibiotics need to be discussed wherever antibiotics can be used.