146.3 🩺 內科專科考前版

146.3.0.1 1️⃣ 22E 更新

• DoxyPEP: not for bites; primarily STI prevention (different context)
• Rabies vaccine schedule simplification (2024 WHO): 4-dose IM (Day 0, 3, 7, 14) — used to be 5-dose
• Rabies single-dose monoclonal Ab (rabishield) in development (replacing HRIG with mAb)
• Capnocytophaga sepsis awareness: especially in splenectomy / cirrhotic — fulminant rapid mortality

146.3.0.2 2️⃣ 台灣 context

• 狂犬病 rabies: 自 2013 起野生動物 (鼬獾) rabies 回流 — bat / 野生動物 contact → PEP recommended
• 公費 PEP available (CECC 處理)
• 台灣 dog bites 多家養; 公衛追蹤
• Vibrio vulnificus: 沿海 + 肝病 → 必排除 in marine wound + cellulitis
• 健保 Augmentin 廣泛使用

146.3.0.3 3️⃣ Tropical Bite Issues

• Snake envenomation: ID region, antivenom; secondary infection 較少
• Scorpion / spider: usually no infection
• Centipede: 蜂窩性組織炎 occasional

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