For Clinicians | Bite and Scratch Wound Antibiotic Prophylaxis Without a 48-Hour Recheck

Bite and Scratch Wound Antibiotic Prophylaxis Without a 48-Hour Recheck

By Dr. Jamie Wilkey, PharmD, Director of Clinical Education 
Medically reviewed and edited by Kristen Carpenter, PA-C

September is National Preparedness Month, and at Jase we love this month. I’d like to focus today on something most preparedness aids skip: animals. This is part one of our two-part Animals + Disaster series. Part one covers the attacks, the bites and scratches from animals and how a delay of care can affect their treatment. And we will end the article with a rabies and TDAP refresher because no bite and scratch article would be complete without that part. Part two covers stings, which behave nothing like bites: the reaction that gets mistaken for an infection, and the one that actually needs epinephrine.

You already know how to manage a bite or a scratch. What makes them interesting in a disaster is the last line of the guideline, the one that says see them back in 48 hours. That initial check and/or recheck delay makes a big difference. Today we’re talking about how that decision changes when you have to make the whole call up front. This is decision support for you as a clinician, not a self-treatment guide for your patients.


The first 48 hours of a bite wound (for cats and dogs)

Let’s start with the fresh, ouchy animal bite wound itself. A cat bite is a narrow, deep puncture that seeds bacteria under the skin and closes over the top, which is why cat bites infect around 30% of the time against 2 – 25% for dog bites.¹ Cleaning the wound well is key here. Irrigate with a syringe or a high-pressure system, 1% to 5% povidone iodine in normal saline, or potable water when you’re out of hospital.¹ Then leave it open. Closure is for cosmetic wounds (mostly the face), and cat bites stay open regardless.¹ None of that really needs a clinic. What you lose without a clinic though is an expert eye’s second look.

Now onto the recheck. Forty-eight hours isn’t some arbitrary number. Bite infections declare early, cat bites typically inside 12 to 18 hours, showing up as erythema, induration, pain and purulent drainage.¹ Most of what’s going to turn has turned inside those first 48 hours. Observation doesn’t prevent infection. It catches it while it’s still small and still local. With a provider, that look is yours to catch early. Without one, someone in the household is doing it. 

When nobody sees it at all

In a real disaster most of these wounds never get a clinician right away, either. Which makes the brief you give patients ahead of time worth more than anything you’d do at the visit. It’s short.

Wash the wound right away and thoroughly, soap and running water, and potable water is fine when there’s nothing sterile.¹ ² Leave it open, don’t tape or butterfly it closed.¹ Write down what bit them and whether the animal can be found again, because that answer is the difference between observing a dog for 10 days and starting a rabies series. ³

Then give them a very, very specific watch list (not just, ‘if it gets worse, call me’): spreading redness, swelling, warmth, pus, or a red streak running up the limb.¹ Those signs can be muted in an immunocompromised patient.¹ Also fever and pain way out of proportion to what is expected. When Kristen (the article reviewer) is in clinic, she’s watching bites around joints (especially hands) way more carefully than soft tissue (osteomyelitis risk). Cat bites tend to declare within 12 to 18 hours, so the first day is the one to keep an eagle eye on it.¹

And be clear about what the trigger does. If the bite gets worse, the best move is reaching a clinician, however far or inconvenient that is, not resorting to medications on hand and guessing. 

Who gets antibiotics when you can’t see them again

Normally you give antibiotics after a bite to a short list of patients and watch everybody else. IDSA’s list: immunocompromised or asplenic, advanced liver disease, a bite area already swelling, a moderate to severe wound especially on the hand or face, or a wound that may have gone into periosteum or joint capsule. A three to five day course for this group.⁴ Everyone else gets cleaned up and watched.

If a recheck isn’t available in 48 hours add hand bites to the antibiotic list. It’s the one bite site (hey, that rhymes!) where prophylaxis is proven, cutting infection from 28% to 2%.⁵ ⁶ Past that, the list shouldn’t grow much. The studies never showed antibiotics help an ordinary dog or cat bite,⁵ ⁷ and every course spent on a small, clean one is a course that’s now gone when a bad, messy one shows up.

Amoxicillin-clavulanate is the first line treatment, 875/125 mg twice daily in adults ⁶ and 22.5 mg/kg twice daily in kids.⁸ If you don’t have it, then please know that cephalexin, dicloxacillin and erythromycin have inadequate activity against Pasteurella and should be avoided. ⁹ For penicillin allergy, adults get clindamycin 300 mg three times daily plus ciprofloxacin 500 mg twice daily, or doxycycline. Children get clindamycin 10 to 25 mg/kg divided every 6 to 8 hours plus TMP-SMX. Pregnant and penicillin-allergic, azithromycin 250 to 500 mg daily, watched closely, because the failure rate is high. ⁶

Scratches don’t follow the 48-hour rule

A fresh cat scratch mostly needs soap and water.² There’s no prophylaxis decision to make, because what goes wrong with a scratch takes longer than the 48 hour bite window.

Cat scratch disease (CSD or cat scratch fever) runs on a much longer schedule. A papule comes up at the scratch and sits there 1 to 3 weeks, and a swollen node upstream develops over 1 to 2 weeks.² The patient you see on day two has nothing to find because it hasn’t fully developed yet. What looks like a little scratch on day 2 can turn into a pretty impressive axillary node weeks later and by then they’ve forgotten all about that darn kitty.

Then it mostly handles itself. CSD resolves with supportive care in 90 to 95% of children, though resolving means 2 to 4 months of that node slowly going down.² Azithromycin shrinks the node faster without meaningfully shortening the illness, if you want it: 10 mg/kg on day 1 then 5 mg/kg days 2 through 5, adult max 500 then 250.² The patients who genuinely need treating are the immunocompromised, to keep it from going systemic.²

So the counseling right up front is going to be more helpful than an Rx. A lump may come up in a few weeks, it’s expected and totally normal, and it isn’t a reason to spend an antibiotic course you may need for something worse. One exception: a scratch from a fox or a raccoon is a rabies question. ¹⁰ Let’s get into that next!

Nobody is too late for rabies PEP

Now, this article would be wildly incomplete without bringing up rabies. The CDC says start PEP regardless of how long it’s been, as long as the patient isn’t already showing signs of rabies.¹¹ 

Rabies lives in bats, raccoons, skunks and foxes, at 35%, 29%, 17% and 8% of reported animal cases. ¹⁰ Of the ones that get close enough to expose somebody, about 10% of raccoons are rabid, and more than 20% of skunks and foxes are too. ¹⁰

Rodents and rabbits are the opposite story. Squirrels, chipmunks, rats, mice and their relatives are rarely infected and have never been known to give rabies to a person, so those bites almost never need PEP. ³ The exception is the groundhog, which accounted for about 92% of rabid rodents and lagomorphs reported from 2011 to 2020.¹² Even so, no human rabies death in the US has ever been traced to a rodent or a lagomorph (rabbit, etc).¹²

Before committing to a PEP series, ask whether the animal can be found. A healthy domestic dog, cat or ferret can be confined and observed for 10 days instead. ³ Especially when vaccine and HRIG are hard to reach, that’s the first question. 

Where this fits

In every scenario above, what the patient needed first was clinical decisions: 

  • is this the wound that gets treated?
  • is this the drug that covers Pasteurella?
  • is this the node that’s going to be fine on its own?
  • is this an animal that commonly carries rabies?

Right now that decision is all or nothing. Either they reach a clinician and get it made, or they’re alone with a wound, a hodgepodge medicine cabinet and an internet search.

Jase works on the narrow layer in between: the clinical thinking done ahead of time, by a licensed provider who reviews the request and writes the prescription, for a short list of predictable problems, for emergency use only and after first trying to reach a qualified provider. That’s what we mean by appropriate medical preparation. It’s in no way a replacement for primary care. It’s for the days when primary care isn’t reachable.

We’ll keep publishing how we draw these lines, including the ones we’re still arguing about, because this is grey space and clinicians should be the ones charting it.

The bottom line

When the recheck disappears, the wound hasn’t changed. The safety net did.

So clean it properly, treat IDSA’s short list and add the hand, and hold the line on everything else, because the course you don’t spend today is the one still available next week. Send them out knowing what a turning wound looks like, who to call when they see it, and that a node coming up three weeks later is usually nothing to spend a prescription on. And if rabies is on the table, nobody has missed the window.


Sources

  1. Indramohan G, Marietta M, Collier SA. Animal Bites. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Updated July 5, 2026. https://www.ncbi.nlm.nih.gov/books/NBK430852/
  2. Sabir S, Daley SF, Huang B. Cat Scratch Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Updated December 13, 2025. https://www.ncbi.nlm.nih.gov/books/NBK482139/
  3. Centers for Disease Control and Prevention. Human Rabies Prevention, United States, 2008: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recommendations and Reports. 2008;57(RR-3). https://www.cdc.gov/mmwr/pdf/rr/rr57e507.pdf
  4. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2014;59(2):e10-e52. https://academic.oup.com/cid/article/59/2/e10/2895845
  5. Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. Cochrane Database of Systematic Reviews. 2001;(2):CD001738. https://www.cochrane.org/evidence/CD001738_antibiotics-reducing-rate-infection-after-bites-mammals-such-humans
  6. Ellis R, Ellis C. Dog and Cat Bites. American Family Physician. 2014;90(4):239-243. https://www.aafp.org/pubs/afp/issues/2014/0815/p239.html
  7. Grillo R, Brozoski MA, Moreira SB, da Silva YS, Borba AM, Naclério-Homem MG. Antibiotic prophylaxis for animal inflicted maxillofacial injuries: a systematic review and meta-analysis. Frontiers of Oral and Maxillofacial Medicine. 2024. https://fomm.amegroups.org/article/view/80777/html
  8. Dannenberg MA, Herigon J. Wise Use of Antibiotics: Management Strategies for Common Animal Bites. The Link, Children’s Mercy Department of Evidence Based Practice. April 2025. https://www.childrensmercy.org/health-care-providers/refer-or-manage-a-patient/connect-with-childrens-mercy/newsletter-the-link/the-link-2025/the-link—april-2025/wise-use-of-antibiotics-management-strategies-for-common-animal-bites/
  9. Hasan J, Hug M. Pasteurella Multocida. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Updated May 16, 2023. https://www.ncbi.nlm.nih.gov/books/NBK557629/
  10. Centers for Disease Control and Prevention. Rabies in the United States: Protecting Public Health. https://www.cdc.gov/rabies/php/protecting-public-health/
  11. Centers for Disease Control and Prevention. Rabies Post-Exposure Prophylaxis: Clinical Care for Healthcare Providers. https://www.cdc.gov/rabies/hcp/clinical-care/post-exposure-prophylaxis.html 
  12. Rabies in Rodents and Lagomorphs in the USA, 2011-20. Journal of Wildlife Diseases. 2023;59(4):734-742. doi:10.7589/JWD-D-23-00036. https://bioone.org/journals/journal-of-wildlife-diseases/volume-59/issue-4/JWD-D-23-00036/RABIES-IN-RODENTS-AND-LAGOMORPHS-IN-THE-USA-201120/10.7589/JWD-D-23-00036.full

 

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Psychiatric Medications Need a Different Emergency Plan

Psychiatric Medications Need a Different Emergency Plan

Part 2 of a two-part series on medication readiness during a disruption

By the Jase Medical Team

In Part 1 of this series, we asked a question most people have never considered: If you suddenly couldn’t access your regular medications, which ones would be most important not to interrupt?

The takeaway was simple: your prescriptions aren’t interchangeable. Rather than trying to rank them yourself during an emergency, ask your healthcare team ahead of time which medications should receive the most urgent attention and add that information to your written medication list.

But there’s one category that doesn’t fit neatly into that ranking: psychiatric medications.

With certain psychiatric medications, losing access isn’t the only consideration. How treatment is resumed after an interruption can matter too. Others carry specific concerns if they’re stopped abruptly or if the conditions around you—such as illness, heat, or dehydration—change.

That means simply knowing where a psychiatric medication falls on your priority list may not be enough.

You need to know the plan for an interruption—and what happens afterward.

The Gap in Most Emergency Plans

Disaster planning tends to separate physical health and mental health into two different conversations.

Medication continuity guidance often focuses on chronic prescriptions people may need replaced after an evacuation, such as medications for heart disease, diabetes, thyroid conditions, and other ongoing medical needs. Mental health preparedness, meanwhile, tends to focus on what a disaster can do to someone’s emotional and psychological well-being: stress, anxiety, trauma, crisis support, and recovery.

Both matter. But there’s a patient who can fall directly between those two conversations: the person who was already taking a psychiatric medication before the disruption began.

Their emergency plan needs to account for that medication too.

Why Psychiatric Medications Need Their Own Plan

Psychiatric medications don’t all behave the same way, so this isn’t a medication-by-medication guide. But a few examples show why this category deserves more deliberate planning.

Clozapine is one of the clearest. An interruption isn’t only about missing the medication; how it is restarted can carry its own clinical considerations. Benzodiazepines present another concern: for someone who is physically dependent on one, abruptly stopping can cause serious withdrawal, including seizures or delirium. Lithium illustrates a different kind of problem, because dehydration and changes in fluid balance can increase the risk of toxicity even when someone hasn’t intentionally changed how they’re taking it.

These examples aren’t instructions for what to do with any particular medication. They’re the reason the instructions need to come from your own prescriber before an emergency happens.

The takeaway isn’t to memorize how each psychiatric medication behaves. It’s to understand that “I’ll just restart it when I get more” may not be an appropriate plan.

Ask Before Anything Happens

There is one useful preparedness question to bring to your psychiatrist, primary care provider, or other prescriber:

“If I can’t fill this medication for several days, what do you want me to do?”

You aren’t asking for permission to change your medication on your own or creating a DIY dosing plan. You’re asking your prescriber to tell you, in advance, what you should do if a disruption affects access.

Then write the answer somewhere you’ll actually find it.

Keep it with your current medication list, along with the medication name, dose, prescriber, pharmacy, allergies, and important treatment information. If a spouse, parent, adult child, or other trusted person helps with your healthcare, make sure they know where that information is too.

NAMI’s Portable Treatment Record is one resource designed to help individuals and families keep important mental health treatment information organized and accessible.

Make Sure the Information Can Leave With You

Having the plan written down only helps if you can access it when normal life is disrupted.

Research examining medication loss during disasters found that people who had prepared an emergency bag were 5.7 times more likely to evacuate with their medications than those who hadn’t.

For psychiatric medications, preparedness doesn’t mean accumulating extra prescriptions or trying to work around prescribing rules. Some medications in this category are controlled substances with specific legal and dispensing requirements.

The practical preparation is much simpler: keep the medications you currently have and the treatment information that goes with them organized so they’re ready to leave with you.

Your emergency bag shouldn’t just have a flashlight, charger, water, and insurance documents. Your medication plan needs a place in it too.

If Access Is Already Interrupted

If you’re already unable to access a psychiatric medication, don’t use a generic online guide to decide how to stop, restart, stretch, reduce, or otherwise change it.

Contact your prescriber or pharmacist for guidance specific to your medication and medical history. If your usual provider is unavailable, another healthcare professional may be able to help determine the appropriate next step.

The goal of preparing ahead isn’t to make these clinical decisions yourself. It’s to avoid having to figure out what your prescriber would want you to do while the pharmacy is closed, you’re away from home, or the rest of an emergency is already demanding your attention.

If you or someone you care for is experiencing a mental health crisis or needs immediate support in the United States, call or text 988.

The Emergency Plan Most People Never Write

There is nothing to buy for this part of medical preparedness.

There is simply a conversation to have while your next appointment is still just a normal appointment and your next refill is still just a normal refill.

Part 1 of this series was about knowing which of your medications needs your attention first if access is disrupted. For psychiatric medications, take that preparation one step further: know what your prescriber wants you to do if access is interrupted—and make sure that answer can travel with you.

Because the middle of an emergency is not the time to discover that stopping and restarting a medication may each require their own plan.

The Jase Medical Team is a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation: clinically grounded readiness that complements, rather than replaces, primary care and the healthcare professionals you already trust.


This article was prepared by the Jase Medical content team for informational purposes only and does not constitute medical advice. Prescription requirements, emergency dispensing rules, insurance coverage, and controlled-substance regulations vary by medication, jurisdiction, and individual circumstances. Consult a licensed healthcare provider or pharmacist regarding your specific medications.

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Which of Your Medications Actually Cannot Wait?

Which of Your Medications Actually Cannot Wait?

Part 1 of a two-part series on medication readiness during a disruption

By the Jase Medical Team

There are five prescription bottles sitting on your counter. You take all five regularly, you have some medication left in each bottle, and your pharmacy is closed until Monday.

So you start doing the math: Which one matters most? Which one can wait?

It sounds like a reasonable question. The problem is that most of us have never been given the information needed to answer it. We tend to think about our daily medications as one list. We count them, refill them, pack them for a trip, and assume that being prepared means making sure they’re all accounted for.

Medically, they aren’t interchangeable. Different medications work differently in the body, and an interruption in one prescription may carry very different considerations than an interruption in another. Occasionally, the medication that seems easiest to go without is exactly the one a clinician would tell you to prioritize.

That’s why one of the most useful things you can add to your medication list isn’t another bottle.

It’s a ranking.

Your Medication List Is Only Half the Plan

Keeping an up-to-date medication list is one of the simplest things you can do for your medical preparedness. It should include each medication’s name, dose and frequency, along with your prescriber, regular pharmacy, and relevant medication allergies. Keep a copy accessible and take it with you when you travel.

That information helps another healthcare professional pick up the thread of your care if your normal provider or pharmacy isn’t available. But there’s another piece most medication lists don’t include: which prescriptions should receive the most urgent attention if access is interrupted.

The order isn’t necessarily obvious, and it isn’t something you should determine from a generic online ranking. Your diagnosis, medication, dose, medical history, and other factors can all matter. There are even medications for which illness, injury, or other physical stress may affect a patient’s needs.

In other words, the goal isn’t to memorize somebody else’s medication hierarchy. It’s to know your own.

Have Your Healthcare Team Help You Rank Them

At your next appointment, through a portal message, or the next time you speak with your pharmacist, ask:

“If I temporarily couldn’t access my medications, which of these would be most important not to interrupt?”

This isn’t asking which medications you can skip, stretch, or ration. It’s asking a healthcare professional who knows your prescriptions to identify which access problem would need to be addressed first.

Then write that information directly on your medication list.

If you manage medications for an older parent or another family member, help them have the same conversation with their healthcare team. The goal isn’t for family members to make medication decisions themselves. It’s to make sure everyone knows where to focus their attention if normal access suddenly changes.

That turns a medication list from an inventory into a preparedness tool.

Let the Ranking Guide Your Preparation

Once you know what matters most, you can focus your preparation there.

If getting every prescription onto a longer dispensing interval isn’t realistic, for example, start the conversation with the medication your healthcare team has identified as the highest priority. For an appropriate non-controlled medication, you might ask your prescriber and pharmacist whether a longer dispensing interval makes sense.

Insurance rules, prescription schedules, and dispensing restrictions vary, so this isn’t about accumulating medication or deciding how much you need on your own. It’s about making the most important access issue the first one you try to solve.

This is the same kind of prioritization sensible families already use elsewhere. We know which bills can’t wait, which insurance documents matter, and which phone numbers we’d need if something went wrong. Medical preparedness applies that same forethought to the prescriptions we depend on.

If Access Is Already Disrupted

If the pharmacy is already closed or you’ve unexpectedly run out of an important prescription, the ranking does not become a rationing plan. Don’t start stretching, skipping, doubling, or otherwise changing how you take your medications based on something you read online.

Instead, contact your prescriber or pharmacist as soon as possible. If your regular pharmacy is unavailable, another pharmacy may be able to help determine your options. Bring your prescription bottles and written medication list, call ahead when possible, and give the pharmacist time to work with you.

Emergency dispensing options vary by medication and location. The purpose of knowing your priorities beforehand is not to make treatment decisions yourself; it’s to know which problem deserves your attention first while you work with a healthcare professional to solve it.

Where JaseCase Fits, and Where It Doesn’t

At Jase Medical, we think about appropriate medical preparation in two separate layers.

The first is your maintenance medication: the prescriptions you already take to manage existing medical conditions. That’s what this article is about. Your regular healthcare team should remain at the center of decisions about those medications.

The second layer is contingency medication for certain acute illnesses that may occur while normal healthcare access is disrupted. That’s where JaseCase fits. Each request is reviewed by a licensed provider who writes the prescriptions for that individual. JaseCase medications are intended for emergency use when appropriate, after you’ve first attempted to reach a healthcare provider.

JaseCase doesn’t replace your maintenance prescriptions, and it isn’t a substitute for your primary care provider or pharmacist. It’s a separate layer of appropriate medical preparation.

Make the Decision Before You’re Under Pressure

Appropriate medical preparation doesn’t always mean acquiring something. Sometimes it means having the right information before circumstances force you to need it.

A written medication list tells another healthcare professional what you take. Adding your clinician-informed priorities tells you where to focus first if access becomes a problem.

That’s a small addition to your preparedness plan, but it can remove a major question from an already stressful situation.

Because if you ever find yourself standing at the counter looking at five prescription bottles and wondering which problem needs to be solved first, that isn’t the moment you should have to figure it out.

Coming Next: Psychiatric Medications Need Their Own Conversation

There is one group of medications that deserves a more nuanced conversation: psychiatric medications. Interruptions can carry considerations that aren’t obvious from the prescription label and shouldn’t be reduced to a generic ranking.

In Part 2, we’ll look specifically at psychiatric medication readiness during a disruption and what patients should discuss with their own prescriber before access becomes a problem.

The Jase Medical Team is a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation: clinically grounded readiness that complements, rather than replaces, primary care and the healthcare professionals you already trust.


This article was prepared by the Jase Medical content team for informational purposes only and does not constitute medical advice. Prescription requirements, emergency dispensing rules, insurance coverage, and controlled-substance regulations vary by medication, jurisdiction, and individual circumstances. Consult a licensed healthcare provider or pharmacist regarding your specific medications.

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Everyone should be empowered to care for themselves and their loved ones during the unexpected. Check out our recent lifesaving products today.

Recent Posts

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Wound Infection Signs: When to Use Antibiotics and When to See a Doctor

Wound Infection Signs: When to Use Antibiotics and When to See a Doctor

By the Jase Medical Team

It’s day three after you cut your forearm.

Yesterday, the area around the cut was a little pink. Today, it looks angrier. Maybe it feels warmer, too.

So you start wondering: Is my cut infected? Do I need an antibiotic? Or is this just what healing looks like?

The reassuring answer is that some redness, warmth, tenderness, and mild swelling during the first day or two can be part of normal wound healing.

What matters more is what happens next.

If the redness is spreading instead of settling down, the pain or swelling is getting worse, drainage or pus appears, or you begin feeling sick, the picture changes.

But even then, an antibiotic isn’t automatically the solution. Most of what can go wrong with a wound starts with another question:

What kind of problem is this?

Normal Healing vs. Wound Infection: Watch the Direction

A fresh cut triggers inflammation as your body begins repairing damaged tissue. That can make the area immediately surrounding the wound look red, warm, mildly swollen, or tender.

Redness alone doesn’t mean infection.

Instead, watch the trajectory.

A wound that is gradually becoming less painful and irritated is moving in the direction we’d expect from healing. A wound that becomes increasingly red, swollen, warm, or painful after the first couple of days—or develops pus or spreading redness—deserves more attention.

Signs that should prompt you to contact a healthcare professional include:

  • Redness that is expanding around the wound
  • Increasing warmth, swelling, or pain
  • Pus or cloudy drainage
  • Fever or feeling increasingly unwell
  • Red streaking extending away from the wound
  • A wound that is worsening rather than healing

And if symptoms are severe or progressing quickly, don’t wait for a routine appointment.

If There’s an Abscess, an Antibiotic Can’t Drain It

Suppose the problem isn’t simply redness around a cut. Instead, a painful, swollen pocket of pus has formed underneath the skin.

That’s an abscess.

And this is one of the most important limitations of an antibiotic: a pill can’t open and drain a pocket of pus.

Incision and drainage is the primary treatment for many skin abscesses. Depending on the situation, a clinician may prescribe antibiotics in addition to drainage—but antibiotics don’t necessarily replace the procedure.

It’s similar to an infected tooth. Medication may sometimes help control infection or buy time, but it doesn’t perform the procedure that fixes the underlying problem.

No oral antibiotic in any emergency medication kit—including ours—can drain an abscess.

If you have a painful, enlarging lump, significant pus collection, or a wound that appears to need drainage, get it evaluated rather than trying to solve the problem with an antibiotic alone.

Don’t Forget the Tetanus Question

There’s another wound-care question that has nothing to do with antibiotics:

When was your last tetanus shot?

Most people remember “every 10 years,” and that’s correct for routine tetanus vaccination.

But wounds can change the timeline.

For certain dirty or major wounds—including puncture wounds and wounds contaminated with dirt or soil—a booster may be recommended if it has been five or more years since your last tetanus-containing vaccine and you’ve completed the initial vaccine series.

So imagine you’re working in the garden, step on a nail, and realize your last tetanus booster was eight years ago.

You may still think you’re covered because you haven’t reached the familiar 10-year mark.

For that type of wound, however, it’s worth contacting a healthcare professional about whether a booster is due.

Your wound plan isn’t just about infection. Sometimes the most important medication decision is a vaccine, not an antibiotic.

Sometimes an “Infected” Red Leg Isn’t Infected

Here’s another reason not to diagnose a wound infection based on redness alone.

Research suggests that roughly one in three people initially thought to have cellulitis actually have another condition instead.

One common mimic is stasis dermatitis, an inflammatory skin condition associated with circulation problems in the legs. It can cause redness, swelling, warmth, and skin changes that resemble an infection.

Contact dermatitis can cause similar confusion.

That’s particularly relevant if you’ve been applying an over-the-counter antibiotic ointment containing neomycin. Neomycin is a well-known cause of allergic contact dermatitis. The resulting redness, itching, or rash can then look like the original wound is getting worse.

The instinct may be to add more antibiotic ointment to what looks like an infection—when the product itself may be contributing to the irritated skin.

If the picture isn’t clear or the redness continues to worsen, that’s another reason to have a clinician look at it rather than repeatedly treating it yourself.

Diabetes and Circulation Problems Change the Wound Plan

If you have diabetes or peripheral vascular disease, wounds deserve additional attention.

Peripheral vascular disease can reduce blood flow to the affected tissue. That can slow healing and make it harder for the body—and sometimes medications delivered through the bloodstream—to reach the area effectively.

Diabetes can also be associated with neuropathy, which may reduce sensation. A blister, cut, or pressure injury can therefore become more significant before pain alerts you that something is wrong.

If you have one of these conditions, don’t rely solely on pain to tell you how serious a wound is. Check wounds carefully and involve your healthcare team sooner if healing isn’t progressing normally.

When Does a Wound Need Urgent Medical Care?

Some wound problems shouldn’t be managed by waiting to see whether an oral antibiotic works.

Seek prompt medical evaluation for rapidly spreading redness or swelling, significant red streaking, severe or rapidly worsening pain, fever or systemic illness, substantial pus or a suspected abscess, or a wound that is becoming significantly worse.

Deep wounds, significant punctures, animal or human bites, wounds involving important structures, and wounds heavily contaminated with soil or floodwater may also need professional evaluation.

And if the skin is rapidly changing color, pain seems dramatically out of proportion to what the wound looks like, or you become severely ill, seek emergency care.

Rare but aggressive soft-tissue infections can require IV medications and immediate surgery. An oral antibiotic at home is not a substitute for that level of treatment.

So When Do Antibiotics Actually Fit?

Antibiotics can have an important role when a clinician determines that a bacterial wound or skin infection is present and that antibiotic treatment is appropriate.

One example is spreading cellulitis associated with a wound.

But even there, the medication is only one part of the clinical picture. The wound may need cleaning, drainage, evaluation for a foreign object, a tetanus booster, or another intervention depending on what happened and what the clinician sees.

At Jase Medical, that distinction matters.

JaseCase includes physician-prescribed contingency medications for certain common bacterial infections when normal healthcare access is disrupted. Every request is reviewed by a licensed medical provider, who determines whether the medications are appropriate and writes the prescriptions for the individual.

If you develop signs of a wound infection, try to reach an appropriate healthcare provider first. Contingency medication is for situations where normal access is genuinely unavailable—not a reason to delay care for a wound that needs a procedure or urgent evaluation.

Know What the Pill Can’t Do

When a wound starts looking worse on day three, it’s tempting to reduce the decision to:

Antibiotic or no antibiotic?

A better question is:

What does this wound actually need?

Sometimes it’s routine wound care and more time. Sometimes it’s an antibiotic. Sometimes it’s drainage. Sometimes it’s a tetanus booster. Sometimes the redness isn’t an infection at all.

And occasionally, the right answer is to stop looking in the medicine cabinet and get to medical care.

At Jase Medical, we’re a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation. We’d rather tell you what a medication can’t do than let you discover its limits when an infection is getting worse.

Because being medically prepared isn’t simply having the right prescription.

It’s knowing when the prescription is—and isn’t—the right tool.

The Jase Medical Team is a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation: clinically grounded readiness that complements, rather than replaces, primary care and the healthcare professionals you already trust.


This article was prepared by the Jase Medical content team for informational purposes only and does not constitute medical advice. Prescription requirements, emergency dispensing rules, insurance coverage, and controlled-substance regulations vary by medication, jurisdiction, and individual circumstances. Consult a licensed healthcare provider or pharmacist regarding your specific medications.

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For Clinicians | Carbon Monoxide Poisoning Recognition

For Clinicians | Carbon Monoxide Poisoning Recognition: The Question That Beats the Symptom List

By Dr. Jamie Wilkey, PharmD, Director of Clinical Education 
Medically reviewed and edited by Kristen Carpenter, PA-C

September is National Preparedness Month, so we’re spending it on the disasters that actually turn up in your patients’ lives. One of them arrives with no smell, no color, and no symptom you can trust: carbon monoxide (CO). A family can be getting hurt for days without knowing, because symptoms alone can’t separate it from whatever is going around. Headache, nausea and fatigue are so common that we as clinicians typically match them to whatever is going around then (the flu in late January, heat exhaustion in July, etc). Today you’re going to get a refresher on how CO poisoning works, who is most at risk, where it happens most commonly, and how to help patients who may be experiencing this silent, un-smelly, and deadly gas exposure.

How often does CO exposure actually kill someone?

Rarely, compared to how often it happens. CO sends roughly 50,000 people to US emergency departments every year.¹ In 2021 it killed about 500 people unintentionally, and about 500 more by suicide.²

(Everything that follows uses the unintentional numbers. Intentional poisoning is coded and reported separately, so it isn’t mixed into any figure in this article.)

That difference between 50,000 affected and 500 dead is thanks to physiology and it’s good news. CO binds hemoglobin with about 250 times the affinity of oxygen, and what it forms, carboxyhemoglobin, is reversible.3 Get the patient into fresh air and it clears on its own, with a half-life of about five hours on room air and about an hour on high-flow oxygen.4 Symptoms start around 10% COHb, and killing a healthy adult usually takes levels above 50%.3 Most exposures never come close, because the source was weak, the room wasn’t sealed, or somebody opened a door.

When someone dies it is usually due to concentration, not duration. The power goes out, a generator comes on, and it’s running somewhere it shouldn’t be. For example, a gasoline engine in an enclosed space drives the concentration up fast, and rapid high-level exposure incapacitates a person before they can get themselves out.3

That’s the difference between the household that shows up at your office feeling flu-ish for three days and the person found unconscious on the garage floor. Same gas, but different exposures.

Who is most at risk for unintentional CO poisoning deaths?

When I think of CO poisoning, I picture a young family with babies and toddlers, poisoned in their own house while they sleep. The death data says otherwise. Adults 45 and older are roughly two thirds of it, and children under 15 are 3%.3 Children don’t tolerate CO better. It’s just that risk is around machines, and the person nearest to (or operating) the machine is an adult. Kids still get exposed, but they show up in ED visits instead of death certificates. Children aged 0 to 9 have the highest rates of poison center calls and CO-related ED visits of any age group.5

Proximity to the CO-emitting device is the whole ballgame here. In one review of disaster-related poisonings, two thirds of the fatal generator cases involved a generator placed indoors, and another third involved one placed outside but too close to the house. Most of the nonfatal cases traced to an attached garage, or a spot right outside a window.6 

That’s also why men are about four out of five of these deaths.3 Those same incidents average two people poisoned each, so the man who dies usually isn’t the only one exposed…he’s the one who was closest to the exhaust.6

So where does it actually happen, and when? 

At home, about three quarters of the time.3 Thirteen percent happen in temporary shelters (cabins, campers and trailers people are sleeping in), mostly from a heater or a generator. Eight percent happen inside vehicles, where somebody ran a generator or an LP heater in there, or burned charcoal in the car.3 Another 34 deaths in 2022 were in detached structures like the shed and the detached garage.


And it isn’t always a generator. Most CO deaths happen in the cold months, 55% of them from November through February, and the winter version of this runs on heating equipment: furnaces, room and space heaters, and the vent that quit working. Heating appliances were the second-largest category in CPSC’s 2022 count at 76 deaths, and charcoal accounted for 18 of the 20 solid-fuel deaths.3 

Geography decides what happens after. The most rural addresses carry about three times the share of CO deaths you’d expect from their population,3 and those are the same patients sitting furthest from an ED in a real emergency.

What actually raises suspicion for CO poisoning?

Ask,  “Who else in the house feels the same way?”

It is simple, short and helps flag CO poisoning separately from other ailments with similar symptoms. 

That question has been tested. In the study that validated it, 65 winter patients presented with headache or dizziness and no known exposure. Symptomatic cohabitants alone identified occult CO poisoning with 75% sensitivity and 90% specificity, and the authors called it the most dependable marker they had.7 

The second question is, “Does it get better away from the house?”

You can guess why this is helpful: if you get away from the source and feel better then that’s your answer. COHb falls by half in about five hours on room air,4 so the patient who spends a workday out of the building feels better by afternoon and gets re-dosed the moment they walk back in. Headaches that lift in the car and return overnight are the pattern. Ask about the dog, too. The dog doesn’t leave for long the way you and your kids do for work and school.

The exposure window is days, not hours. In a New York study of pediatric CO poisoning, four hours without power raised the odds of an ED visit by at least 50%, and by 150% or more when the outage was large-scale, with the risk tracked across the days that followed.8

Why a normal pulse ox proves nothing

The bedside tool, aka a pulse ox, most of us reach for first fails hard on CO poisoning. You see, in a case of poisoning:

  • Standard pulse oximetry still reads falsely normal. A two-wavelength oximeter can’t tell carboxyhemoglobin from oxyhemoglobin, so it counts the poisoned blood as saturated.4,5 That 99% on the monitor is measuring the wrong molecule.
  • Pulse CO-oximetry, the seven-wavelength kind that reports an SpCO, is better and still can’t clear the patient. Performance is good, not perfect, and it isn’t adequate to exclude CO poisoning when you already suspect it.4 A normal SpCO with a suspicious history means you still draw the blood.
  • The COHb level doesn’t tell you how sick someone is. There’s no validated relationship between the number and the symptoms.4 Treat the patient and the history, not the number.
  • Cherry-red skin is a postmortem finding. It’s in every review and it is not a bedside sign because your patient is still alive.5

Two extra notes: a COHb level runs on venous blood, so nobody needs an ABG for this.4 And a smoker’s baseline can sit as high as 10%, which is enough to blur real exposure at the low end.5

The test that helps the most and is free is so simple. It is as we just learned above: asking who else in the house feels this way.

What to do when you suspect it

Get everyone out of the building first, into outdoor air, and call 911 if anyone has symptoms. Fresh air starts the clock by itself, and high-flow oxygen speeds it up: about five hours to clear half the COHb on room air, about one hour on 100% oxygen.4 Oxygen is the treatment.

Then evaluate everyone who was inside, including the ones who say they feel fine. Those incidents average two people poisoned each.6 Before anyone goes home, tell the family what to watch for. New neurologic or cognitive symptoms can show up 2 to 40 days after the exposure, and delayed sequelae appear in something like a quarter to a half of hospitalized patients.1,5 The risk runs higher with loss of consciousness, a longer exposure, a COHb at or above 25%, or abnormal imaging.¹ Neuropsychological testing belongs a month or two out…not at discharge.5

If you confirm CO poisoning in an adult who was alone, with nobody else affected and no obvious source, you really need to consider intent here. Roughly half of American CO deaths are suicides,² and that patient does not look different when they appear in your office from the one who parked the generator too close. 

What to tell them before the next outage

Almost everyone already knows not to run a generator indoors. In a study of 32 generator owners in North Carolina, people ran them in attached garages, screened porches, covered patios, basements and sheds, and many of them did not count an attached garage or a covered porch as being “in the house.”9 Only half of them had a CO alarm.9

So the counseling point for you to remember with your patients isn’t a warning, it’s a distance and a direction. Outside only, at least 20 feet from the house, exhaust pointed away from doors, windows and vents. Never a garage, a basement, a crawlspace, a shed or a porch, and opening the door doesn’t fix it. Never leave a car running in an attached garage.10

Then, get the alarm! A CO alarm that is battery-operated or with battery backup, one on every level outside the sleeping areas, tested monthly.10 Most states require them in homes now.² 

We publish regularly about what supplies to have on hand to be prepared in a disaster. There’s nothing to stock for carbon monoxide other than a working alarm on every floor and making sure there is a minimum of 20 feet between the generator and the house. What prepares us is asking who else in the house feels the same way.

That’s appropriate medical preparation too. We’re in no way a replacement for primary care. We’re the clinicians who would rather you catch this before it even happens.

The bottom line

CO doesn’t announce itself, and the symptom list won’t separate it from other sicknesses. The household will. One sick person is usually a virus. A whole household that feels better away from the house is a building problem. The pulse ox won’t tell you which one is in front of you.

So when the power has been out a couple of days and a family turns up feeling wrung out, ask who else feels it and whether it lifts when they leave. If the answer points at the house, get everyone outside and call 911 for anyone symptomatic.


Sources

  1. American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Carbon Monoxide Poisoning; Shih RD, Tomaszewski CA, Kaji A, Diercks DB. A Critical Issue in the Management of Adult Patients Presenting to the Emergency Department With Acute Carbon Monoxide Poisoning: Approved by the ACEP Board of Directors January 22, 2025. Annals of Emergency Medicine. 2025;85(4):e45-e59. https://pubmed.ncbi.nlm.nih.gov/40118649/
  2. Hampson NB. Carbon monoxide poisoning mortality in the United States from 2015-2021. Clinical Toxicology. 2023;61(7):483-491. https://doi.org/10.1080/15563650.2023.2237667
  3. U.S. Consumer Product Safety Commission. Non-Fire Carbon Monoxide Deaths Associated with the Use of Consumer Products: 2022 Annual Estimates. May 2026. https://www.cpsc.gov/s3fs-public/Non-Fire-Carbon-Monoxide-Deaths-Associated-with-the-Use-of-Consumer-Products-2022-Annual-Estimates.pdf
  4. Internet Book of Critical Care (EMCrit). Carbon monoxide poisoning. https://emcrit.org/ibcc/co/
  5. McMahon K, Launico MV. Carbon Monoxide Toxicity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Updated April 19, 2025. https://www.ncbi.nlm.nih.gov/books/NBK430740/
  6. Iqbal S, Clower JH, Hernandez SA, Damon SA, Yip FY. A review of disaster-related carbon monoxide poisoning: surveillance, epidemiology, and opportunities for prevention. American Journal of Public Health. 2012;102(10):1957-1963. https://pmc.ncbi.nlm.nih.gov/articles/PMC3490658/
  7. Heckerling PS, Leikin JB, Maturen A. Occult carbon monoxide poisoning: validation of a prediction model. American Journal of Medicine. 1988;84(2):251-256. https://pubmed.ncbi.nlm.nih.gov/3407653/
  8. Northrop AJ, Do V, Flores NM, Wilner LB, Sheffield PE, Casey JA. Power Outages and Carbon Monoxide Poisoning in Children. Pediatrics. 2025;155:e2024068213. https://pubmed.ncbi.nlm.nih.gov/40320254/
  9. Damon SA, Poehlman JA, Rupert DJ, Williams PN. Storm-Related Carbon Monoxide Poisoning: An Investigation of Target Audience Knowledge and Risk Behaviors. Social Marketing Quarterly. 2013;19(3). https://pmc.ncbi.nlm.nih.gov/articles/PMC4559492/
  10. U.S. Consumer Product Safety Commission. What to Know About Generators and Carbon Monoxide (CO). CPSC publication 468. https://www.cpsc.gov/s3fs-public/468-WhattoKnowGenerators_2022.pdf

 

Lifesaving Solutions

Everyone should be empowered to care for themselves and their loved ones during the unexpected. Check out our recent lifesaving products today.

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Join Our Newsletter

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