Anesthetize the wound as for other wounds.
The skin around the wound can be cleaned with a soft sponge and 1% Betadine solution to remove obvious contaminants. The wound should be thoroughly cleansed with 200-1000 cc of Sterile saline using a 30 cc syringe with a splash guard attached. Minimum amount of saline to be used is 200cc's/bite.
Debride wound margins to viable tissue with a #15 scalpel blade.
Do not suture hand or foot bites, puncture wounds, or wounds in immunosuppressed patients.
DOG bites less than 6 hours old may be sutured without increasing risk of infection if adequately irrigated and debrided.
CAT and HUMAN bites should not be sutured, except on the face.
Local care ultimately prevents infection more effectively than any prophylactic antibiotics.
Prophylactic antibiotics are recommended in DOG or RAT bite wounds to the hands, feet and face. Recent dog bite wounds that can be completely cleansed and debrided and that are in well-vascularized areas may not require antibiotics.
Prophylactic antibiotics indicated in:
- Cat bits
- Human bites
- Puncture wounds
- Hand and foot wounds
- Wounds with care delayed beyond 12 hours
|Animals||Organisms||Antibiotics||Consider Rabies Vaccine?|
|Bat, Skunk, Raccoon||Unknown||Augmentin or Doxycycline||YES|
|Cat||Pasteurella Multocida/ Staph||Augmentin or TMP/SMX PLUS Clinda||NO|
|Dog||P. canis and multicida, Staph, Bacteroides, Fusobacterium, EF-4, Capnocytophagia||Augmentin or TMP/SMX PLUS Clinda||YES|
|Human||Viridans Strep, Staph, Corynebacterium, Eikenella, bacteroides, Peptostrep||Augmentin (Unasyn) or Clindamycin AND TMP/SMX||NO|
See Red Book for alternatives because of allergies, etc.
Toxoid should be given, if indicated. Also, consider giving dTaP per Red Book recommendations.
Prophylaxis guidelines can be found in the Harriet Lane Handbook or the Red Book. Call the Health Department for advice on obtaining the vaccine/immunoglobulin.
The wound should be checked 24-48 hours after initial treatment.
Consider admission in infected bites covering an extensive area, bites with large tissue loss requiring grafting, in hand bites where patient's compliance with wound management is poor, bites that violate facial cartilage, joint space, bone, tendon, and bites with neurovascular injury.
Nurse will complete the animal incident/rabies investigation report.
Review signs/symptoms of wound infection and advise them to promptly seek medical attention with any concerns. Inform family of risk of infection despite proper wound care and antibiotics.
Hodge D, and Tecklenburg F, Bites and Stings in Fleisher & Ludwig. Pediatric Emergency Medicine, Baltimore, MD, 2000
Rabies Control Act of South Carolina with 1990 and 1992 amendments. South Carolina DHEC
Knapp JF. Updates in Wound Management for the Pediatrician. Pediatric Clinics of North America 46(6):1201-13, 1999.
Chen E, Horing S, Sheperd SM, et al. Primary Closure of Mammalian Bites. Academic Emergency Medicine 7(2):157-61, 2000.
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