Bites, animal/human/insects

Refer to Cellulitis (mild-moderate) guideline

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 relevant travel history. See UKHSA guidance on rabies
- If rabies immunoglobulin and/or vaccine is indicated see Rabies Post Exposure Prophylaxis - Acccessing vaccine and immunoglobulin
For all bites assess risk of bloodborne virus infection.
For snakes/spider bites, consider the risk of venomous species: contact ED for further advice.
For non-traditional pets bites, refer to Paediatric ID for advice.

For prophylaxis:

Give 3 days of antibiotics 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.

co-amoxiclav po (see dosing table)

For prophylaxis:

Age	co-amoxiclav oral dose
1 month to 11 months	0.25mL/kg of 125/31mg/5mL suspension TDS
1 year to 5 years	5mLs of 125/31mg/5mL suspension TDS
6 years to 11 years	5mLs of 250/62mg/5mL suspension TDS
12 years to 17 years	One 625mg tablet TDS OR 10mLs of 250mg/62mg/5mL suspension TDS if patient cannot take tablets

For treatment:

Age	co-amoxiclav oral dose
1 month to 11 months	0.5mL/kg of 125mg/31mg/5mL suspension TDS
1 year to 5 years	10mLs of 125mg/31mg/5mL suspension TDS
6 years to 11 years	10mLs of 250mg/62mg/5mL suspension TDS
12 years to 17 years	One 625mg tablet TDS OR 10mLs of 250mg/62mg/5mL suspension TDS if patient cannot take tablets

Option for intravenous antibiotic (if unable to take oral antibiotics or severely ill):

co-amoxiclav iv:

1 month to 2 months: 30 mg/kg iv BD

3 months to 17 years: 30 mg/kg (Max dose 1.2g) iv TDS

For penicillin allergy (non-severe and severe)

co-trimoxazole po (see dosing table)

Age	co-trimoxazole oral dose
6 Weeks - 5 Months	120mg BD
6 Months - 5 Years	240mg BD
6 Years - 11 Years	480mg BD
12 Years - 17 Years	960mg BD

Option for intravenous antibiotic (if unable to take oral antibiotics or severely ill):

co-trimoxazole iv For child 6 weeks - 17 years: 18mg/kg (max dose 960mg) iv BD

Insect bites

Animal/Human Bites

Preferred

Alternative

Editorial Information