Bites, human + animal
Animal and human bites
- Thorough irrigation is essential.
- Debridement of wound may also be necessary.
- For all bites check tetanus vaccine status and refer to Tetanus prone wounds guideline.
- For all bites consider rabies prophylaxis/vaccination if recent travel history. See UKHSA guidance on rabies
- For all bites assess risk of bloodborne virus infection.
- For snake/spider bites, consider the risk of venomous species: contact ED for further advice.
- For non-traditional pet bites, refer to ID for advice.
For prophylaxis:
Give 3 days of antibiotic if indicated. See table for criteria to decide if prophylaxis is required.
|
Type of bite |
Skin NOT broken | Skin broken but NO blood drawn | Skin broken and blood drawn |
| Human | Prophylaxis NOT indicated |
Prophylaxis to be considered ONLY if: Bite in high-risk area* If patient at high risk of infection due to co-morbidities** |
Prophylaxis indicated |
| Cat | Prophylaxis NOT indicated |
Prophylaxis to be considered ONLY if bite could be deep |
Prophylaxis indicated |
| Dog or other traditional pets (hamsters, guinea pigs, rats, rabbits, etc) | Prophylaxis NOT indicated | Prophylaxis NOT indicated |
Prophylaxis to be considered if: Bite in high-risk area* Patient at high risk of infection due to co-morbidities**
Prophylaxis indicated if: Penetrated bone, joint, tendon or vascular structures. Is deep, is a puncture or crush wound, or has caused significant tissue damage. Is visibly contaminated (for example, if there is dirt or a tooth in the wound). |
|
Exotic animal (snakes, lizards, spiders, bats, etc) |
Contact Micro/ID | ||
*Includes hands, feet, face, genitals, skin overlying cartilaginous structures or an area of poor circulation
**Such as diabetes, immunosuppression, asplenia or decompensated liver disease
For treatment:
Offer 5 days treatment course for people with a human or animal bite if there are symptoms or signs of infection, such as increased pain, inflammation, fever, discharge or an unpleasant smell.
Take a swab if discharge from the wound and send to microbiology. Re-assess wound after 24-48 hours if no improvement.
Preferred
co-amoxiclav 625mg po tds
If unable to take PO or severely unwell: co-amoxiclav 1.2g iv tds
Prophylaxis 3 days and treatment 5 days
Alternative
For penicillin allergy (non-severe)
doxycycline 100mg po bd PLUS metronidazole 400 mg po tds
If unable to take PO or severely unwell: ceftriaxone 2g od iv PLUS metronidazole 400mg po tds (or 500mg iv tds if NBM)
For penicillin allergy (severe) and or MRSA positive patient
doxycycline 100mg po bd PLUS metronidazole 400 mg po tds
If unable to take PO or severely unwell: co-trimoxazole 960mg po bd (iv only if NBM), increase to 1.44g iv bd for severe infection
Prophylaxis 3 days and treatment 5 days
References
NICE guideline 184 Human and Animal Bites https://www.nice.org.uk/guidance/NG184