Antibiotic Prophylaxis

As discussed in other chapters, antibiotic prophylaxis is effective when a wound has more than baseline bacterial contamination, antibiotics effective against expected pathogens are chosen, and such antibiotics are given as soon as possible to achieve antimicrobial blood levels before repair. However, as commonly practiced, antibiotic prophylaxis from the ED is suspect for the following reasons: (1) the use of antibiotics for simple, uncomplicated lacerations fails to satisfy the first requirement; (2) the use of cephalexin for cat bites fails to meet the second requirement; and (3) handing the patient a prescription on discharge fails the third. 6 Antibiotic prophylaxis should be initiated in the ED, before significant wound manipulation, and with agents that rapidly achieve antibacterial blood levels.

The following types of wounds have shown evidence to support the use of continued antibiotic prophylaxis upon discharge from the ED:

1. Intraoral lacerations: penicillin

2. Complicated human bites: amoxicillin/clavulanate or penicillin plus a first-generation cephalosporin

3. Complicated dog bites: amoxicillin/clavulanate or penicillin plus a first-generation cephalosporin

4. Cat bites: penicillin or amoxicillin/clavulanate

5. Plantar puncture wounds, particularly through athletic shoes: ciprofloxacin

Although antibiotic prophylaxis is commonly employed for patients with comorbid conditions predisposing to wound infection (diabetes, cirrhosis, advanced age, and immunosuppression), there is little supporting evidence for this practice in all circumstances except for the types of wounds described above.

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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