7-9
smaller scars and promote faster healing.
- Use prophylactic antibiotics in all bites. If antibiotics are used for an active infection, the duration of
therapy should be 7-14 days depending on the severity of the infection and the clinical response. Most
likely organisms for human bites: Streptococcus viridans 100%; Bacteroides 82%.
a. Early (not yet clinically infected): Amoxacillin/Clavulanate (Augmentin) 875/125 mg bid po x 5 days
b. Later (Signs of infection 3-24 hours): Ampicillin/Sulbactam 1.5gm q 6h IV or cephotoxin 2.0gm q 8h
IV or ticarcillin/clauvulanate 3.1 gm q 6h IV or piperacillin/tazobactam 3.375 gm q 6h IV or 4.5 gm
q 8h IV. If penicillin allergic, use clindamycin 300 mg qid po (+) either ciprofloxacin 500 mg bid po or
trimethoprim/sulfamethoxazole DS po bid x 7 days.
c. Bat, raccoon, and skunk bites (very high infection risks): Amoxacillin/Clavulanate (Augmentin)
875/125 mg bid or 500/125 mg tid po x 7 days; Alternates: Doxycycline 100 mg bid po x 7 days.
d. Cat bites (80% become infected): Amoxacillin/Clavulanate (Augmentin) 875/125 mg bid or 500/125
mg tid po x 7 days; Alternates: Cefuroxime axetil 0.5 gm q 12 hours po or doxycycline 100 mg bid
po. Resistant organisms seen, so non-healing infections may respond to penicillin G IV or penicillin
VK po. Observe for osteomyelitis.
e. Dog bites (5% become infected): Amoxacillin/Clavuanate 875/125 mg bid or 500/125 mg tid po
x 7 days. Alternates: Clindamycin 300 mg qid po (+) ciprofloxacin 500 mg bid po x 7 days.
Observe for osteomyelitis.
f. Bites from hospitalized patients: Consider including coverage for aerobic gram negative bacilli. - Give tetanus antitoxin if >5 years since last dose.
- Use narcotics or benzodiazepines judiciously for agitation (see Pain Assessment and Control).
- Consider anti-rabies therapy (see ID: Rabies)
a. Infiltrate around inoculation site with 1⁄2 dose of human rabies immune globulin (HRIG 20 IU/kg), give
remaining 1⁄2 IM into gluteal region.
b. If patient is not immunized against rabies, give human diploid cell rabies vaccine (1 ml IM in deltoid
x 5 as detailed on Immunization Chart in Preventive Medicine Chapter) beginning immediately. For
individuals who have been fully vaccinated against rabies previously (including ID and IM protocols
given to most SOF personnel), give 1 ml IM booster dose in deltoid immediately at presentation and
again 3 days later. Pre-exposure vaccination does not guarantee protection against rabies, but it does
buy time to get to definitive treatment if bitten, and it does decrease the number of post-exposure
boosters required.
c. If possible, isolate suspected animal source and observe 10 days for signs of rabies.
Patient Education:
General: This wound has a high risk of infection so close follow-up is needed. Return promptly for fever
and hot, red, or swollen wound, particularly if accompanied by swollen nodes or streaks (blood poisoning)
traveling away from the wound.
Follow-Up Actions:
Wound Care/Return Evaluation: Recheck patient in 24-48 hours if not infected at first visit, and followed
daily if infected.
Evacuation/Consultation Criteria: Bites with extensive tissue loss, involvement of complex/deep structures,
penetration of the skull, and infection failing to respond to above antibiotic regimens should be evacuated
ASAP. Consult general surgery or infectious disease specialist in these cases, and others as needed.