Randomized controlled trial of prophylactic antibiotics for XXXX bites with refined cost model.

@entity1 @entity235 @entity281 @entity79 @entity10188
OBJECTIVE: The aim of this study was to determine the rate of @entity281 at which it is cost-effective to treat @entity235 bite wounds with antibiotics. METHODS: Our study was composed of two parts. First we performed a randomized, double-blind controlled trial (RCT) to compare the @entity281 rates of @entity235 bite wounds in @entity1 given @entity10188 versus placebo. Subjects were immunocompetent @entity1 presenting to the emergency department (ED) with @entity235 bite wounds less than 12 hours old without suspected @entity79 , and who had structured follow-up after two weeks. Second, we developed a cost model with sensitivity analysis to determine thresholds for treatment. RESULTS: In the RCT, primary outcomes were obtained in 94 @entity1 with @entity235 bites. The overall wound @entity281 rate at two weeks was 2% [95% CI 0 to 7%]. Two of 46 @entity1 (4%) receiving no antibiotics developed @entity281 , while none of the 48 @entity1 (0%) receiving prophylactic antibiotics developed an @entity281 (absolute reduction 4% [95% CI -1.0 to 4.5%]). Using a sensitivity analysis across a rate of @entity281 from 0-10%, our cost model determined that prophylactic antibiotics were cost effective if the risk of wound @entity281 was greater than 5% and antibiotics could decrease that risk by greater than 3%. CONCLUSION: Our wound @entity281 rate was lower than older studies and more in line with current estimates. Assuming that prophylactic antibiotics could provide an absolute risk reduction (ARR) of 3%, it would not be cost effective to treat wounds with an @entity281 rate of less than 3% and unlikely that the ARR would be achievable unless the baseline rate was greater than 5%, suggesting that only wounds with greater than 5% risk of @entity281 should be treated. Future work should focus on identifying wounds at high-risk of @entity281 that would benefit from antibiotic prophylaxis.
