Bites (Human and Animal)

Antimicrobial prescribing: NHS Fife
NHS Fife

Clinical features

  • Treat all cat and human bites
  • Treat dog bites if there is a bite involving the hand, foot, face, tendons or ligaments; also if the patient is immunocompromised, cirrhotic, asplenic, or has a prosthetic joint or heart valve

Investigations

  • If systemically unwell or joint involved, consider blood cultures
  • Swab from bite, if purulent

Infection Control

Basic universal precautions

Treatment

Consider risk of:

  • Tetanus (soiled wound)
  • Rabies (animal bite)
  • Blood borne viruses (human bite)

Review at 24-48h: not all potential pathogens are covered by empirical treatment regimens for these patients. Discuss with Microbiology if failing to improve

IV

CO-AMOXICLAV IV 1.2g 8 hourly

If true penicillin allergy, discuss with Microbiology

Oral

For all bites:

CO-AMOXICLAV PO 625mg 8 hourly

If true penicillin allergy and human bites:

CLARITHROMYCIN PO 500mg 12 hourly 

PLUS

METRONIDAZOLE PO 400mg 8 hourly

If true penicillin allergy and animal bites:

DOXYCYCLINE PO 100mg 12 hourly 

PLUS

METRONIDAZOLE PO 400mg 8 hourly

Duration: 7 days total (IV + Oral)