A 32-year old woman was pecked viciously on the finger by a swan that she was feeding in a park. She came to the Accident and Emergency Department several days later, when her finger was swollen and discoloured a deep blue. A wound swab was taken and she was started on oral cephradine 500 mg three times daily. Culture grew Pseudomonas aeruginosa sensitive to ciprofloxacin and other antibacterial agents, but resistent to cephradine, co-amoxiclav and others. Not surprisingly, the infection failed to respond to cephradine and treatment was changed to oral ciprofloxacin 750 mg twice daily with excellent results.
This case suggests that whilst many animal bites (including human bites) can be managed with co-amoxiclav, ciprofloxacin should be added in bites from animals living in water.
Ebrey, R.J. & Hayek, L. J., Tobay Hospital, Torquay, Devon, U.K.
Letter, The Lancet 1997; 350:340