How would you treat this patient’s rat bite?

A 26-year-old healthy doctoral candidate was doing research in the university laboratory when she was bitten on the finger by one of the rats she was handling. She comes to your office seeking guidance.

How would you treat this patient?

A. Prophylactic antibiotics to cover Pasteurella multocida and Capnocytophaga canimorsus.
B. Prophylactic antibiotics to cover Streptobacillus moniliformis.
C. Prophylactic antibiotics to cover Spirillum minus.
D. Conservative wait and watch. Symptoms usually occur 3 to 10 days after exposure to an infected rodent, but can be delayed as long as 3 weeks. Look for fever, vomiting, headache, muscle pain, joint pain, or rash.
E. Give the patient a tetanus shot.

(Answer and discussion on next page)

Answer: Give tetanus shot and wait and watch 

In healthy individuals, it is acceptable to wait and watch for uncomplicated bites for up to 3 weeks before starting a penicillin-based antibiotic. Symptoms to look for include fever, vomiting, headache, muscle pain, joint pain, and rash. The organism to be covered is Streptobacillus moniliformis. 

Differential diagnoses. Spirillum minus organisms are seen in Asian rodent bites and Pasteurella multocida are seen with dog bites. Tetanus shots are recommended if not up to date. 

Outcome of the case. The patient was given a penicillin-based antibiotic and had an uneventful complete recovery continuing her doctoral thesis work.