Makindo Medical Notes

Animal and human bites carry a high risk of infection and require careful management. Prompt wound cleaning and proper wound care, combined with antibiotics in high-risk patients, are essential to prevent serious complications. Human bites, in particular, demand additional considerations like HIV and hepatitis B prophylaxis. Close monitoring for infection is crucial, and early treatment with appropriate antibiotics is recommended for both animal and human bites.

Animal Bites

If rabies is a concern, scrub the wound with soap and water for at least 15 minutes, followed by rinsing and applying a disinfectant (e.g., iodopovidone) as soon as possible after exposure. Prompt wound cleaning can significantly reduce the risk of rabies and other infections.

Use of Antibiotics

While the use of antibiotics for animal bites is sometimes debated, pre-emptive antimicrobial therapy is recommended for 3–5 days in certain high-risk patients to prevent infection. Early antibiotics are crucial in the following cases:

• Immunocompromised patients;
• Asplenic individuals;
• Patients with advanced liver disease;
• Pre-existing or resultant oedema of the affected area;
• Moderate to severe injuries, particularly to the hands or face;
• Injuries that may have penetrated the periosteum or joint capsule.

Recommended Antibiotics for Animal Bites

• First-line treatment: Amoxicillin-Clavulanate (Augmentin) is typically the preferred antibiotic for covering both aerobic and anaerobic organisms.
• Penicillin allergy: Clindamycin plus either Ciprofloxacin or Doxycycline to provide anaerobic and broad aerobic coverage.
• For severe infections or bites to hands/face: Intravenous Piperacillin-Tazobactam or Ceftriaxone may be used.

Human Bites: All human bites require the following treatments:

• Prophylactic antibiotics: Always recommended due to the high risk of infection from oral flora.
• Post-exposure prophylaxis for HIV: Consider within 72 hours, especially if the biter’s saliva is contaminated with blood. Although human bites generally have a low risk of transmitting HIV, the risk increases if blood is drawn from the victim’s wound.
• Hepatitis B vaccination: Administer within 24 hours if the patient is not already immunized.

Recommended Antibiotics for Human Bites

• First-line treatment: Amoxicillin-Clavulanate (Augmentin) is preferred.
• Penicillin allergy: Clindamycin plus either Ciprofloxacin or Doxycycline can be used to cover both aerobic and anaerobic bacteria commonly found in human bites.
• For deep wounds or severe infections: Intravenous Piperacillin-Tazobactam or Ceftriaxone may be required.

Treatment Guidelines for Animal and Human Bites

• Do not suture animal or human bites: These wounds should be irrigated copiously, left open to drain, and dressed properly. Suturing increases the risk of trapping bacteria inside the wound, leading to infection.
• Examine the wound daily for signs of infection.
• Elevate the injured body part during the first few days, especially if swollen, to aid healing. Use passive methods like a sling (for outpatients) or a tubular stockinet with an intravenous pole (for inpatients).
• If the wound becomes infected: Treat immediately with appropriate antibiotics.
• Delayed primary closure: If no signs of infection are present, the wound may be closed 72 hours after the injury.