Bites, Human
[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 transmited 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.
Usual Pathogens
Polymicrobial:
Streptococcus spp
S. aureus/MRSA
Eikenella spp
Haemophilus spp
Anaerobes
Prophylaxis
Infection rate up to 50%. Prophylaxis within 12 hours of bite is recommended if:
- moderate/severe
- edema, pre-existing or resultant
- puncture wounds
- bone/joint involvement
- hand or face injuries
- asplenic patients
- advanced liver disease
- immunocompromised.
| Empiric Therapy | Duration | |
|---|---|---|
| Amoxicillin-clavulanate | 40mg/kg/d PO div tid | 3-5 days |
Alternative
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Cefuroxime axetil | 30mg/kg/d PO div bid | 3-5 days |
| +/- | ||
| Metronidazole | 15-30mg/kg/d PO div bid |
ß-lactam allergy ≤ 8 years old
| Empiric Therapy | Duration | |
|---|---|---|
| Clindamycin | 20mg/kg/d PO div tid | 3-5 days |
| + | ||
| TMP/SMX (if > 1 month old) | 8-12mg TMP/kg/d PO div bid |
ß-lactam allergy > 8 years old
| Empiric Therapy | Duration | |
|---|---|---|
| Doxycycline | 2-4mg/kg/d PO div q12-24h | 3-5 days |
| +/- | ||
| Metronidazole | 15-30mg/kg/d PO div bid |
Treatment
| Empiric Therapy | Duration | |
|---|---|---|
| Amoxicillin-clavulanate | 40mg/kg/d PO div tid | 7-10 days |
Alternative
| Empiric Therapy | Duration | |
|---|---|---|
| Cefuroxime axetil | 30mg/kg/d PO div bid | 7-10 days |
| +/- | ||
| Metronidazole | 15-30mg/kg/d PO div bid |
ß-lactam allergy ≤ 8 years old
| Empiric Therapy | Duration | |
|---|---|---|
| Clindamycin | 20-40mg/kg/d PO div tid | 7-10 days |
| + | ||
| TMP/SMX (if > 1 month old) | 8-12mg TMP/kg/d PO div bid |
ß-lactam allergy > 8 years old
| Empiric Therapy | Duration | |
|---|---|---|
| Doxycycline | 2-4mg/kg/d PO div q12-24h | 7-10 days |
| +/- | ||
| Metronidazole | 15-30mg/kg/d PO div bid |
Severe/Limb-threatening
| Empiric Therapy | Duration | |
|---|---|---|
| Piperacillin-tazobactam | 240-300mg piperacillin/kg/d IV div q6-8h | 10-14 days |
| or | ||
| Imipenem | 60mg/kg/d IV div q6h | 10-14 days |