Bites — animal or human

• Human or animal bites carry a high risk of infection 
• Includes fists cut by teeth in fight — treat as a human bite​
• High risk of infection if 
• Delayed presentation (8 hours or more)
• Puncture wounds that can't be debrided adequately (eg cat, crocodile bites)
• Wounds on hands, feet or face
• Tendon, joint or bone involvement
• People with weakened immune system — dialysis, diabetes

Check

• Head-to-toe exam with attention to
• Embedded foreign bodies (eg teeth)
• Bone, joint or tendon involvement
• Wounds over knuckles ​​that may connect with tendon or joint
• Immunisation status — tetanus

Do not

• Do not suture or tightly close a wound bite — will trap infection inside

Do

All bites

• Swab wound for MC&S
• Clean and dress
• If small, clean, uncomplicated wound — antibiotics not needed

Severe bite or established infection — medical consult

• Consider sepsis — signs and symptoms can include
• High or low temperature
• Fast breathing
• Fast pulse
• Low BP or dizziness
• Confusion and/or agitation

All other bites

• Give antibiotics
• Amoxicillin-clavulanic acid oral — adult 875+125mg, child 22.5+3.2mg/kg/dose up to 875+125mg — doses — twice a day (bd) for 5 days
• If unable to give oral antibiotics — medical consult for
• Cefazolin IV — adult 2g, child 50mg/kg/dose up to 2g — doses — twice a day (bd)

• AND Metronidazole IV — adult 500 mg, child 12.5 mg/kg up to 500 mg — twice a day (bd)  

• If allergy to penicillin — medical consult for
• Metronidazole oral — adult 400mg, child 10mg/kg/dose up to 400mg — doses — every 12 hours (bd)
• AND Trimethoprim-sulfamethoxazole oral — adult 160+800mg, child 4+20mg/kg up to 160+800mg — doses — twice a day (bd) for 5 days
• Review daily