Synopsis
Assess bite depth and anatomical injury, irrigate and debride early, select proportionate antimicrobial prophylaxis or treatment and complete tetanus, rabies and blood-borne-virus prevention.
- Document species, ownership and health, location and country, provocation, time, wound mechanism and the patient's immune and vaccination status.
- Immediate high-volume irrigation, removal of foreign material and appropriate debridement reduces inoculum and allows true depth assessment.
- Examine distal perfusion, sensation, tendon function and joint movement before local anaesthetic or repair whenever possible.
Key red flags
A clenched-fist wound over a metacarpophalangeal joint can penetrate tendon and joint despite a tiny opening.
A small dorsal wound over a metacarpophalangeal joint after punching teeth may track through extensor tendon into the joint.
Investigation priorities
Define depth, devitalised tissue, retained tooth, tendon, joint, nerve and vascular injury.
Management branches
Any human or animal bite has broken the skin or caused crush injury.
- Control bleeding, remove jewellery, provide analgesia and irrigate copiously with potable water or saline while removing visible contamination and foreign material.
- Record species, location, timing, provocation, country, animal availability, host immune status, allergies and vaccination history.
Key medicines
Co-amoxiclavGive 625 mg orally three times daily for three days as prophylaxis or five days as treatment for an adult bite wound.
Doxycycline plus metronidazoleGive doxycycline 200 mg orally on day one then 100 to 200 mg daily, plus metronidazole 400 mg orally three times daily, for three prophylaxis days or five treatment days.