Lyman D
Family Medicine Residency Program, University of Tennessee Health Science Center, Jackson, USA.
Tenn Med. 2001 Mar;94(3):95-7.
In summary, several errors occurred with this patient. One, the patient should have been treated prophylactically for P. multocida, as most cat bites become infected. In the patient not allergic to penicillin, augmentin is the drug of choice, not erythromycin. Two, rabies postexposure prophylaxis should have been advised immediately after assessing the significance of the exposure. A feral cat must be assumed to be rabid if it cannot be quarantined for 10 days. Therefore, the bite or scratch from such an animal constitutes a significant rabies exposure. Three, initial postexposure rabies prophylaxis must include both HRIG and the first of a series of either HDCV, RVA, or PCEC.
总之，该患者出现了几处失误。其一，由于大多数猫咬伤都会感染，该患者本应接受针对多杀巴斯德菌的预防性治疗。对于不过敏的患者，首选药物是阿莫西林克拉维酸钾，而非红霉素。其二，在评估暴露的严重性后，应立即建议进行狂犬病暴露后预防。如果一只野猫无法被隔离10天，就必须假定它患有狂犬病。因此，这种动物的咬伤或抓伤构成了严重的狂犬病暴露。其三，初始狂犬病暴露后预防必须同时包括人狂犬病免疫球蛋白和一系列狂犬病疫苗（如人二倍体细胞狂犬病疫苗、狂犬病病毒吸附疫苗或鸡胚细胞狂犬病疫苗）中的第一剂。
