Bites, Human
[Infect Dis Clin N Am 2021;35:219-36; Clin Infect Dis 2014;59:e10-52]
- Irrigation and debridement necessary.
- Immobilization and wound elevation, if possible, are beneficial.
- HIV and Hepatitis B & C have very rarely been transmitted by human bites. Assessment of risk factors and relevant management should be considered.
- Risk factors for developing osteomyelitis:
delay in initial treatment
inadequate debridement
primary closure of wound.
- Cloxacillin, cephalexin/cefazolin, clindamycin, and macrolides NOT effective against Eikenella spp.
- Pus/deep wound cultures recommended in established infections.
Streptococcus spp
Staphylococcus spp/MRSA
Anaerobes
Eikenella spp
Haemophilus spp
Corynebacterium spp
Prophylaxis
Infection rate up to 50%. Prophylaxis within 12 hours of bite is recommended if:
- moderate/severe (wound > 3 cm)
- edema, pre-existing or resultant
- bone/joint involvement
- hand or face injuries
- asplenic patients
- advanced liver disease
- immunocompromised
- implants (e.g. prosthetic heart valves).
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin-clavulanate | 875mg PO bid | 3-5 days |
Penicillin/amoxicillin allergy
| Empiric Therapy | Dose |
Duration |
|---|---|---|
| Cefuroxime axetil | 500mg PO bid | 3-5 days |
| + | ||
| Metronidazole | 500mg PO bid |
Cefuroxime allergy
| Empiric Therapy | Duration | |
|---|---|---|
| [Doxycycline | 100mg PO bid | 3-5 days |
| +/- | ||
| Metronidazole] | 500mg PO bid | |
| or | ||
| [TMP/SMX | 1 DS tab PO bid | 3-5 days |
| + | ||
| Metronidazole] | 500mg PO bid |
Treatment
| Empiric Therapy | Duration | |
|---|---|---|
| Amoxicillin-clavulanate | 875mg PO bid | 7-10 days |
Penicillin/amoxicillin allergy
| Empiric Therapy | Dose |
Duration |
|---|---|---|
| Cefuroxime axetil | 500mg PO bid | 7-10 days |
| + | ||
| Metronidazole | 500mg PO bid |
Cefuroxime allergy
| Empiric Therapy | Duration | |
|---|---|---|
| [Doxycycline | 100mg PO bid | |
| +/- | ||
| Metronidazole] | 500mg PO bid | |
| or | ||
| [TMP/SMX | 1 DS tab PO bid | 7-10 days |
| + | ||
| Metronidazole] | 500mg PO bid |
Moderate
| Empiric Therapy | Duration | |
|---|---|---|
| Ceftriaxone | 2g IV daily | |
| + | ||
| Metronidazole | 500mg PO bid |
Severe/Limb-threatening
| Empiric Therapy | Duration | |
|---|---|---|
| Piperacillin-tazobactam | 3.375g IV q6h | 10-14 days |
| Penicillin allergy | ||
| Meropenem | 500mg IV q6h | 10-14 days |