When crocs attack: Which antibiotic works best?

Wound infections are common after crocodile attacks — but which antibiotic to use?

Advice has been notably absent from Australian guidelines until now, but Queensland clinicians believe they have the answer.

A review of wound infections in 14 people attacked by crocodiles, by Cairns Hospital clinicians shows a highly diverse range of pathogens are responsible.

The bacteria isolated from wounds — such as Pseudomonas aeruginosa and Proteus vulgaris — may have come from the crocodile’s oral flora, the patient’s skin or the water or soil during the attacks, the researchers say.

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In the absence of clear guidelines, the patients were treated with a myriad different empirical antibiotics including ceftriaxone, metronidazole, gentamicin and doxycycline.

Taking into account the pathogens seen in crocodile attacks in the Top End, they said a simple broad-spectrum agent would be the best prophylaxis after an attack.

“An empirical regimen of oral amoxicillin–clavulanate for high risk wounds and mild infections would appear appropriate, reserving intravenous piperacillin–tazobactam for more severe infections,” they suggested.

Anyone attacked by a crocodile should also have a tetanus jab.

More information:

MJA 2017; online.