Most commonly caused by bats, raccoons and domestic animals with aggressive behaviour
Never give prophylaxis for small rodents (ex. mice, rats, squirrels).
Treatment includes: active (vaccine) and passive (immunoglobulins)
If domestic animal (ex. neighbours dog) bites you, and is asymptomatic, animal should be monitored for 10 days for signs of rabies before giving dual therapy.
If domestic animal (ex. neighbours dog) bites you, and is symptomatic, animal should be monitored by vet for signs of rabies before giving dual therapy
If wild animal bites you, it should be captured, killed and brain tested for rabies before giving dual therapy.
If the animal is unavailable, give the dual therapy regardless.
Raccoon/Bats = treat right away
Uncomplicated Healthy Females: TMP-SMX for 3 days 1st line
Complicated UTIs: Ciprofloxacin
- Ex. Structural issues, immunocompromised, Diabetic, Catheter associated, Elderly, Male
Pregnant Females: Amoxicillin 1st line, then Nitrofurantoin (but avoid sulfa drugs in final 6 weeks of pregnancy - risk of kernicterus) - ex. TMP-SMX
Children: ensure ultrasound is performed if febrile or under 2 years old. If patient has recurrent and multiple UTIs do VSUG + Ultrasound
- Neonate: Ampicillin IV
- Infant: Ampicillin Oral
Asymptomatic Elderly patients in Nursing home do not require treatment. No decrease in overall mortality or recurrence with treatment. Leave them alone!
Note: Treat asymptomatic bacteriuria only if
2) urologic intervention
3) hip arthroplasty
Note: Nitrofurantoin cannot be used in black pregnancy (risk of G6PD oxidative stress)
Note: Most common bugs: KEEPS
Klebsiella, E. coli, Enterococcus, Proteus, Staph saprophyticus