Animal and Human Bites Management

Clinical assessment

Based on history of the bite (animal type/human, circumstances, time elapsed) and examination of the wound. Assess wound characteristics (depth, contamination, tissue damage) and check neurovascular status and tendon function, especially for bites on extremities.

Investigations

• Thorough wound exploration (under local anesthesia if needed) to assess depth and remove foreign bodies (e.g., tooth fragments).
• X-ray: Consider for suspected fracture, retained foreign body (tooth), or bone involvement (osteomyelitis if infection develops later).
• Wound culture: Usually reserved for clinically infected wounds not responding to empiric therapy.
• Assess Rabies risk (see TRA005).

Diagnostic criteria

History of bite from animal or human resulting in skin break.

Non-pharmacological management

• First Aid/Initial Wound Care: Immediate and thorough cleaning with soap and copious amounts of clean water or saline solution. This is crucial for reducing infection risk.
• Control Bleeding: Apply direct pressure.
• Antiseptic Application: Apply Povidone iodine 10% or Chlorhexidine 0.05%. Soak puncture wounds in antiseptic for 15 minutes.
• Debridement: Remove any devitalized tissue and foreign material (under local anesthesia).
• Irrigation: Copious irrigation of the wound after cleaning/debridement.
• Wound Closure: General Rule: DO NOT SUTURE BITE WOUNDS (primary closure) due to high infection risk. Exceptions may be considered for cosmetically sensitive areas (face) if wound is <6-8h old, clean, minimal tissue damage, and after meticulous cleaning/debridement (requires careful judgment and follow-up). If closure considered, delayed primary closure (after 3-5 days of observation/dressing) is often preferred over primary closure.
• Leave most bite wounds open to heal by secondary intention, or consider delayed primary closure.
• Dressings: Apply sterile dressing. Pack deeper wounds loosely if left open.
• Immobilization/Elevation: Splinting and elevation may be needed for bites on extremities, especially hands, to reduce swelling and pain.

Pharmacological treatment

• Tetanus Prophylaxis: Give TT 0.5 ml IM if not immunized within last 10 years. Consider Tetanus Immunoglobulin (TIG) for severe/contaminated wounds in unimmunized/incompletely immunized individuals.
• Analgesia: Paracetamol or NSAIDs for pain.
• Prophylactic Antibiotics: Indications:
• - Deep puncture wounds (especially cat bites).
• - All human bites.
• - Moderate to severe wounds with crush injury or significant devitalized tissue.
• - Wounds involving bone or joint.
• - Wounds on hands, feet, face, or genitalia.
• - Wounds requiring surgical repair/suture.
• - Wounds in immunocompromised hosts (e.g., diabetes, HIV, asplenia, chronic steroid use).
• Antibiotic Choice (Covers Gram-positives, Gram-negatives, Anaerobes):
• - Amoxicillin/Clavulanate is often first-line (provides broad coverage including anaerobes like Pasteurella from cats/dogs). Dose: Adult 875/125mg PO BID or 500/125mg PO TID. Child: 25-45 mg/kg/day (amoxicillin component) divided BID/TID.
• - UCG Recommendation: Amoxicillin 500mg PO TID (Adult: 15mg/kg/dose Child) PLUS Metronidazole 400mg PO BID (Adult: 10-12.5mg/kg/dose Child) for 5-7 days. (Note: This covers anaerobes but lacks Pasteurella coverage compared to Amox/Clav).
• - Alternatives may include Doxycycline, Moxifloxacin, or Clindamycin + Ciprofloxacin/TMP-SMX.
• Rabies Post-Exposure Prophylaxis (PEP): Assess risk based on animal type, circumstances, vaccination status of animal, and local epidemiology (See TRA005).

Monitoring

Close follow-up within 24-48 hours to assess for signs of infection (most infections manifest within 3 days). Monitor wound healing. Ensure completion of antibiotic course if prescribed.