Human and animal bites
Management:
Assess site and depth of bite and Irrigate (and debride) as necessary
Safeguarding issue?
Seek specialist help from microbiology for bites from wild or exotic animals (including birds and non-traditional pets) or farm animals or other unfamiliar domestic animals as the spectrum of bacteria may be different and there may be risks of non-bacterial infections
Swab if bite infected and discharge
If antibiotics given advised to re-consult within 24-48 hours if not improving
Human bites:
Antibiotic if the skin is broken and it has drawn blood and consider if skin is broken but it has not drawn blood if high risk of infection:
- High risk area (eg hands, feet, face, genitals, skin over cartilage structures or area of poor circulation)
- Person at high risk of complications (eg diabetes, immunosuppression, asplenia, etc.)
Cat bites:
Antibiotics if the bite has broken the skin and drawn blood and consider if the bite has broken the skin but not drawn blood if the wound could be deep
Bites from dogs and other traditional pets:
Antibiotics if it has broken the skin and drawn blood if it:
- Has penetrated bone, joint, tendon or vascular structures
- Is deep, is a puncture or crush wound or has caused significant tissue damage
- Is visibly contaminated (eg if there is dirt or a tooth in the wound).
Consider if it has broken the skin and drawn blood if high risk of infection:
- High risk area - hands, feet, face, genitals, skin over cartilage structures or area of poor circulation.
- Person at high risk of complications eg diabetes, immunosuppression, asplenia etc.
Consider referral/admission/specialist advice:
If systemically unwell, have lymphangitis or have deteriorated despite taking antibiotics
If they are at risk of serious complications due to pre-existing medical conditions
If the bite is in an area of poor circulation
Admit ALL people with penetrating wounds involving arteries, joints, nerves, muscles, tendons or bones
Antibiotics for adults (detailed prescribing guidance for children):
For prophylaxis of infection give 3 days, for treatment of infection give 5 days
1st line: co-amoxiclav 325mg or 625mg TDS
If penicillin allergic: doxycycline 200mg stat then 100-200mg daily WITH metronidazole 400mg TDS; if pregnant and penicillin-allergic seek specialist advice
For children 1st line co-amoxiclav; 2nd line co-trimoxazole if < 12 years old, doxycycline plus metronidazole if ≥ 12 years old
Reference(s):
NICE NG184