This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages without signing in

Antibacterial and antiviral prescribing following bite wounds

Authoring team

  • antibacterial prophylaxis:
    • prophylactic antibacterial therapy should be offered to patients who:
      • sustain bites to the hand, or from humans or cats
      • antibacterial prophylaxis is a reasonable precaution when the wound involves moderate or severe injury, or crush or puncture injury; when oedema is present; when bone or joint penetration is possible; when a bite injury to the face has been closed; when the genital area is involved; for complicated dog bites (e.g. those requiring surgical debridement); for patients who are immunosuppressed, have diabetes or prosthetic heart valves; or where the injury is near a prosthetic joint (1)
      • PHE guidance states (2):
        • human bite
          • assess risk of tetanus, HIV, hepatitis B&C
          • antibiotic prophylaxis is advised
        • animal bite
          • assess risk of tetanus and rabies
          • give antibiotic prophylaxis if cat bite/puncture wound; bite to hand, foot, face, joint, tendon, ligament; immunocompromised/diabetic/asplenic/cirrhotic/ presence of prosthetic valve or prosthetic joint

    • which antibiotic:
      • co-amoxiclav (625mg three times daily for adults) is the antibacterial of choice for initial prophylaxis, or the treatment of established infection, before culture and sensitivity results are available
        • if penicillin allergic (2):
          • metronidazole PLUS doxycycline (cat/dog/man) or
          • metronidazole PLUS clarithromycin (human bite)
          • review at 24 and 48 hours (2) - because the recommended regimen covers the majority, but not all, of the likely pathogens from an animal or human bite

  • antiviral prophylaxis:
    • human bites
      • a risk assessment should be made and, where appropriate, hepatitis B vaccine and/or specific hepatitis B immunoglobulin and/or HIV post-exposure prophylaxis should be offered
      • there is no post-exposure prophylaxis for hepatitis C, which appears to be transmitted more easily than HIV. However, a patient exposed to hepatitis C will need sequential tests for seroconversion, and appropriate referral

NICE have suggested a schemata for managing human and anima bites (3):

 

 

 

Reference:

  1. Drug and Therapeutics Bulletin (2004);42:65-72
  2. Public Health England (October 2014). Management of infection guidance for primary care for consultation and local adaptation
  3. NICE (November 2020). Human and animal bites: antimicrobial prescribing

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.