Makindo Medical Notes

🦷🐕 Animal and human bites carry a high risk of infection and demand careful management. Immediate and thorough wound cleaning + appropriate antibiotics (for high-risk cases) are essential to prevent serious complications. ⚠️ Human bites are especially dangerous, requiring added considerations such as HIV and hepatitis B prophylaxis. Close wound monitoring and early antibiotic treatment reduce the risk of sepsis and long-term disability.

🐕 Animal Bites

• 🚿 Rabies concern: Scrub wound with soap + water for at least 15 minutes → rinse → apply disinfectant (e.g. povidone-iodine).
• 🦠 This reduces the risk of rabies, tetanus, and bacterial infection.
• 💉 Rabies PEP (post-exposure prophylaxis) is indicated based on exposure category and local epidemiology.

💊 Use of Antibiotics

While not always needed for low-risk bites, pre-emptive antibiotics (3–5 days) are recommended for:

• 🧬 Immunocompromised patients
• 🩸 Asplenic individuals
• 🍺 Advanced liver disease
• 💧 Significant oedema at the site
• ✋ Face or hand injuries (high cosmetic/functional risk)
• 🦴 Wounds penetrating periosteum or joint capsule

💊 Recommended Antibiotics for Animal Bites

• 1️⃣ First-line: Amoxicillin–Clavulanate (Augmentin) → covers Pasteurella, streptococci, staphylococci, anaerobes.
• 2️⃣ Penicillin allergy: Clindamycin + Ciprofloxacin (or Doxycycline) → anaerobic + aerobic cover.
• 3️⃣ Severe infections / hand/face bites: IV Piperacillin–Tazobactam or Ceftriaxone.

🧑 Human Bites

🚨 Always considered high risk due to oral flora (Eikenella, anaerobes, strep, staph). Common in fights (“clenched fist injury”), which can track infection into deep structures of the hand.

• 💊 Prophylactic antibiotics: Always indicated.
• 🧬 HIV PEP: Consider within 72h if bite involved blood exposure. Risk is low but not zero.
• 🦠 Hepatitis B: Give vaccine ± HBIG within 24h if unimmunised/exposed.
• 💉 Tetanus prophylaxis as per immunisation status.

💊 Recommended Antibiotics for Human Bites

• 1️⃣ First-line: Amoxicillin–Clavulanate.
• 2️⃣ Penicillin allergy: Clindamycin + Ciprofloxacin/Doxycycline.
• 3️⃣ Deep wounds / severe infection: IV Piperacillin–Tazobactam or Ceftriaxone.

🛠️ Wound Management Principles

• 🚫 Do NOT primarily suture bite wounds → high infection risk. Leave open, irrigate, dress.
• ✅ Delayed primary closure possible at 72h if no infection develops.
• 🔍 Examine wound daily for erythema, pus, spreading cellulitis.
• ⬆️ Elevate affected limb (sling for upper limb, stockinet support for lower limb).
• 🦠 If infection develops → escalate to IV antibiotics, surgical debridement if needed.

📌 Summary

🦷🐕 Bite wounds are dirty wounds by definition. Key steps: 🚿 clean thoroughly → 💉 update tetanus/rabies/HBV as needed → 💊 give antibiotics for high-risk or all human bites → 🔍 monitor closely. Management must balance infection risk, cosmetic outcome, and function.