公 共 衛 生 藥 學 暨 藥 事 管 理 Hygiene Pharmacy and Pharmacy Administration ( 7 ) 100% 8 1 表 一 全 國 提 供 狂 犬 病 疫 苗 的 醫 院 列 表 (human diploid vaccine) (human rabie

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1 Hygiene Pharmacy and Pharmacy Administration 公 共 衛 生 藥 學 暨 藥 事 管 理 常 見 動 物 咬 傷 與 治 療 台 南 新 樓 醫 院 藥 劑 科 藥 師 陳 弘 益 台 北 榮 民 總 醫 院 藥 劑 部 藥 師 丘 俐 倩 摘 要 1% %15-20% % 壹 一 般 考 量 X Sep 藥 學 雜 誌 第 108 冊 87

2 公 共 衛 生 藥 學 暨 藥 事 管 理 Hygiene Pharmacy and Pharmacy Administration ( 7 ) 100% 8 1 表 一 全 國 提 供 狂 犬 病 疫 苗 的 醫 院 列 表 (human diploid vaccine) (human rabies immune globulin, HRIG) human diploid vaccine human diploid vaccine 20 IU/kg ( 0.5 ml) 貳 常 見 咬 傷 viridans streptococci staphylococci Bacteroids species Fusobacterium species peptostreptococci Eikenella corrodens amoxicillin/ clavulanate 875 mg/125 mg bid 3-5 ampicillin/sulbactam 1.5 g q6h cefoxitin 2 g q8h ticarcillin/clavulanate 3.1g q6h 88 THE JOURNAL OF TAIWAN PHARMACY Vol.27 No.3 Sep

3 Pasteurella multocida Staphylococci aureus80% 89% 83%77% 18% 70% Pasteurella multocida Pasteurella multocida 10 penicillin ampicillin piperacillin ceftriaxone penicillin V cefotaxime Pasteurella multocida tetracyclin minocyclin doxycycline Pasteurella multocida penicillin amoxicillin/clavulanate amoxicillin/clavulanate doxycycline cefuroxime axetil (bartonellosis ) azithromycin 500 mg 250 mg Pasteurella multocida streptococci staphylococci Capnocytophaga canimorsus 80% 20% amoxicillin/ clavulanate 875 mg/125 mg bid 3-5 amoxicillin/clavulanate clindamycin (clindamycin ciprofloxacin streptococci) ciprofloxacin ( ) 11 amoxicillin/clavulanate acyclovir Herpesvirus simiae ( ) 1~2 10~20 12 (rat-bite fever) Streptobacillus moniliformis Spirillum minus 13 Streptobacillus moniliformis Spirillum minus Penicillin 14 doxycyclin tetracycline 參 結 論 () 273 Sep 藥 學 雜 誌 第 108 冊 89

4 公 共 衛 生 藥 學 暨 藥 事 管 理 Hygiene Pharmacy and Pharmacy Administration ( ) amoxicillin-clavulanate penicillin G penicillin V 參 考 資 料 : 表 二 人 類 或 動 物 咬 傷 預 防 感 染 的 處 理 <8 > B AIDS 表 三 人 類 或 動 物 咬 傷 的 抗 生 素 使 用 建 議 Pasteurella species, staphylococcus aureus, streptococci, anaerobes, Capnocytophaga, Moraxella, Corynebacterium, Neissera amoxicillinclavulanate cephalosporin trimethoprimsulfamethoxazole ampicillinsulbactam cephalosporin trimethoprimsulfamethoxazole 90 THE JOURNAL OF TAIWAN PHARMACY Vol.27 No.3 Sep

5 amoxicillinclavulanate cephalosporin trimethoprimsulfamethoxazole clindamlycin ampicillinsulbactam Gentamicin clindamlycin gentamicin streptococci staphylococcus aureus, Eikenella corrodens amoxicillinclavulanate cephalosporin trimethoprimsulfamethoxazole clindamlycin ampicillinsulbactam cephalosporin trimethoprimsulfamethoxazole clindamlycin Streptobacillus moniliformis Spirillum minus penicillin V doxycyclin tetracyclin Penicillin V 1. Larry K. Pickering, Georges Peter, Carol J. Baker, Michael A. Gerber, Noni E. Macdonald.Red Book: report of the committee on infectious disease 25 ed. pp Gary R. Fleisher. The management of bite wounds. N Engl J Med 1999; 340: Dendle C, Looke D. Management of mammalian bites. Aust Fam Physician. 2009; 38(11): &ctNode=220&mp=1 6. Goba B. Green, Ian S. Harris, Grace A. Lin, Kyle C. Moylan. The Washington Manual of Medical Therapeutics. 31 ed. pp asp?cuitem= Westling K, Farra A, Cars B, Ekblom AG, Sandstedt K, Settergren B, Wretlind B, Jorup C.Cat bite wound infections: a prospective clinical and microbiological study at three emergency wards in Stockholm, Sweden.Journal of infection 2006; 53(6): Chen TC, Lin WR, Lu PL, Lin CY, Chen YH. Cat scratch disease from a domestic dog. J Formos Med Assoc. 2007; 106: S B Ojukwu IC, Christy C. Rat-bite fever in children: case report and review. Scand J Infect Dis. 2002; 34(6): Teresa KF Wang and Samson SY Wong. Streptobacillus moniliformis septic arthritis: a clinical entity distinct from rat-bite fever?bmc Infectious Diseases. 2007; (7): Sep 藥 學 雜 誌 第 108 冊 91

6 公 共 衛 生 藥 學 暨 藥 事 管 理 Hygiene Pharmacy and Pharmacy Administration Common Animal Bites and Management Hung-Yi Chen 1, Li-Chien Chiu 2 Department of Pharmacy, Sin-Lau Hospital, Tainan, Taiwan 1 Department of Pharmacy, Taipei Veterans General Hospital, Taipei,Taiwan 2 Abstract Every summer vacation period (July and August), many students participate in extracurricular activities more often than before. According to foreign research, it indicates that during the summer vacation, in patients attending pediatric emergency center, about 1% of the them suffered from animal bite. In the United States, there are 470 million people bitten by dogs each year, 40 million people bitten by cats, and about 25 million people are bitten by human beings. Infection rate of cat bites is more than 50%. Infection caused by dog or human bites is about 15-20%. There are deaths due to dog bites annually in the United States. Australia has one of the highest incidences of pet ownership in the world, with the rate of dog ownership by household between 35-42%. It has been estimated that approximately 2% of the population is bitten by a dog annually, of which 100,000 people required treatment and 13,000 people sought treatment in a hospital. In Taiwan, during 1948 to 1958, there was a large-scale outbreak of rabies. Thousands of people were bitten by dog attacks, and resulted in 782 deaths. There is no domestic animal bites data in our country, however, the cases of bites by mammalian animals and even rats are still common. Therefore, we discussed treatment and management of several kinds of animal bites. 92 THE JOURNAL OF TAIWAN PHARMACY Vol.27 No.3 Sep