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Antibacterial and antiviral prescribing following bite wounds

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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

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