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Abstract

Project Summary: Feline bites are the second most common bite injury after canine. The hand and upper extremity are the most common site for bite injuries. The mouths of animals contain many bacteria, so these bites are often treated with 3-5 days of antibiotics to prevent infection. While this practice makes intuitive sense, the data supporting the use of antibiotics to prevent, rather than treat, infection is lacking. The goal of this study is to determine whether prophylactic antibiotics are appropriate and, if so, to determine the appropriate antibiotic treatment duration in patients with cat bites to the hand or forearm but without signs of infection noted within the first 24 hours after the bite. We hypothesize that there is no significant difference in the rate of infection between patients who do and patient who do not receive preventative antibiotics for cat bites to the hand/forearm if there are no signs of infection within the first 24 hours. To test this hypothesis, we have designed a prospective, randomized, placebo-controlled, double-blinded, three arm clinical trial in which patients will be randomized to receive either no active drug (placebo), amoxicillin-clavulanate 875-125mg by mouth (PO) twice daily (BID) for 1 day or amoxicillin-clavulanate 875-125mg PO BID for 5 days. Patients with a penicillin allergy in the antibiotic groups will receive ciprofloxacin 500mg PO BID + clindamycin 300mg PO three times a day (TID)). Patients with allergies to ciprofloxacin or clindamycin will be excluded. Both investigators and patients will be blinded to the intervention assigned. Patient assessments will be performed at baseline (day 0), day 2, day 7?2, day 14?2 and day 30?2 following the cat bite. We expect that administration of antibiotics will not reduce the incidence of infection in patients without signs of infection who are evaluated and treated within 24 hours of bite injury. This finding will provide evidence for the appropriate treatment with antibiotics, which will help minimize unnecessary or overly long courses of antibiotics and side-effects associated with that treatment. This will also support the broader goal of antibiotic stewardship by reducing the number of antibiotics prescribed and thus reducing the evolutionary pressure for bacteria to develop resistance.

Impact Statement: Antibiotic overuse has led to bacteria becoming resistant to those antibiotics, making infections harder to treat successfully. Currently, when a patient is treated for a cat bite, antibiotics are often prescribed to prevent infection. However, very little evidence supports this treatment. This clinical trial will examine whether patients with cat bites to the hand or forearm who are treated with antibiotics have fewer infections or other problems than patients treated with a non-drug placebo pill. If there is no difference in the results, it would indicate the preventative use of antibiotics in these patients may not be needed.

Biography
Dr. Klifto received his PharmD from the Philadelphia College of Pharmacy in 2013. After working as a clinical pharmacist for a few years, he started his training at the Philadelphia College of Osteopathic Medicine, receiving his DO in 2021. During this time, he began his pursuit of clinical research, first in Orthopaedic Surgery and then in Plastic Surgery. He is currently a second-year resident in the Integrated Plastic Surgery Program at the University of Missouri (MU) in Columbia, MO, with an anticipated completion date of 2027. During his time at MU, he has participated in several retrospective clinical studies, further expanding his research experience. Most relevant to this proposal, Dr. Klifto recently completed an evidence-based review of all level I, randomized controlled trials related to antibiotic prophylaxis for prevention of skin and soft tissue infections in Plastic and Reconstructive Surgery. Dr. Klifto’s background in pharmacy, clinical research, and plastic surgery ideally suit him to pursue research into pharmacotherapies in plastic surgery.