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HWN Suggests

Mammalian Bites: ED presentations, evaluation, and management

Strongest evidence for antibiotic prophylaxis are for bites to the hand. There is also some evidence that suggests using prophylactic antibiotics for clinically significant human bites. There is not strong evidence, however, supporting prophylaxis in bites from domestic animals that do not involve the distal extremities...

Augmentin is the oral antibiotic of choice for both prophylaxis and treatment of infected mammalian bites.

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 Animal and Human Bites: When Stitches Are Needed

Most dog bites can be stitched, especially if the wound is large. In general, cat bites are not stitched. Cat bites are usually puncture wounds and can be quite deep. Cat bites have a higher risk of infection than dog bites. Human bites are not usually stitched unless they are on the face or ear. Human bites have a high risk of infection. Most facial bites can be safely stitched. Bites to the hand or foot, whether from an animal or a human, are generally not stitched. These bites carry a high risk of infection, and stitching the wound further increases the likelihood of infection. In some situations, a dog bite to the hand may be stitched.

 Bite injuries: Bark for Dogmentin

Introduction: bite injuries are common encounters in the ED. In North America alone, 2-5 million animal bites occur annually, making up 1% of all ED visits. The most common cause overall of bites are due to canines (90% of cases), followed by cats, then humans, then rodents. Among animal bites, the animal is often provoked. Perhaps most shocking, ~30% of dog bites fatality victims are infants and young children. Outpatient prophylaxis choices: Amoxicillin/clavulanic acid (i.e. “Dogmentin” as we like to call it) is preferred. If penicillin allergic, doxycycline + clindamycin can be given instead.

 Resident Clinical Pearl – Animal Bites

Animal bites, like other wounds, require regular wound care with a focus on meticulous cleaning. Cat bites usually need prophylactic antibiotics, dogs usually do not. All immunocompromised hosts get prophylactic antibiotics.

Articles of Interest

CRACKCast E061 – Mammalian Bites

Pasteurella multocida likely has been overstated as a primary causative pathogen.

Episode 94.0 – Mammal Bites

This week we talk about mammal bites - dogs, cats and humans - with a focus on wound closure, antibiotics and rabies prophylaxis.

Human and Animal Bites: Acute Care and Follow-up

Victims of bite wounds are often emotionally distraught, whether from the severity of the injury, concern about the appearance of the wound, or the fact that their pet has just hurt them. Post-traumatic stress disorder is not uncommon among children who are bitten by dogs. You can do much to calm and reassure bite victims. Here we provide strategies that can minimize the risk of infection and disease and help ensure satisfactory wound healing.

Human and Other Mammalian Bite Injuries of the Hand: Evaluation and Management

The hand is the most common site for bite injuries. Because of specific characteristics of hand anatomy, bite mechanics, and organisms found in human and animal saliva, even small wounds can lead to aggressive infections.

Mammalian Bites

Wound infections from mammalian bites have a complicated microbiology profile. The majority of infections are polymicrobial with a mix of aerobic and anaerobic bacteria. Patients with acute cat bites (<24 hours from the time of the bite) most often have wound cultures that grow Pasteurella organisms, especially Pasteurella multocida.

Mammalian Bites in the Emergency Department: Recommendations for Wound Closure, Antibiotics, and Postexposure Prophylaxis

Prophylactic antibiotics are not warranted for most human-bite wounds, unless they are on the hands or feet. However, transmission of other diseases must remain a concern. HIV transmission, while extremely rare, can occur if the biter had blood in his saliva at the time of the bite. Additionally, hepatitis B and C can be transmitted even through nonbloody saliva contact. Discussion must occur regarding PEP for these viral diseases.

Management of mammalian bites

The main complications of mammalian bites are tissue damage from the bite itself, infection and psychological distress. Injuries sustained from a bite are dependent on the animal species and dentition, ferocity of attack and the anatomical location of the bite. Dog bite wounds are most often crush injuries, lacerations and abrasions resulting from the high pressures generated from the canine...

When your best friend bites: A note on dog and cat bites

The appropriate treatment for dog and cat bites consists of the following: inquiring about the status of tetanus immunization and providing booster doses, as needed; inquiring about the risk of rabies (see below) and arranging appropriate immunoprophylaxis; cleansing and debridement of the wound, and an assessment of the appropriateness of wound closure; an evaluation of the need for prophylactic antibiotics; and management of emotional trauma, which may occur as a result of the bite.

Resources

WikEM

5% of untreated dog bites will become infected (similar to rate of non-bite wounds). 80% of untreated cat bites will become infected.