From the Guidelines
Management of human bites on the USMLE requires prompt and thorough treatment due to the high risk of infection, with amoxicillin-clavulanate 875/125 mg orally twice daily for 3-5 days as the first-line treatment, as recommended by the Infectious Diseases Society of America 1. Initial management includes vigorous irrigation with normal saline or water to clean the wound thoroughly. The wound should be debrided if necessary to remove devitalized tissue. For prophylactic antibiotic therapy, the choice of amoxicillin-clavulanate is based on its coverage of the polymicrobial organisms commonly found in the human oral flora, including Streptococcus, Staphylococcus, and anaerobes like Eikenella corrodens. Some key points to consider in the management of human bites include:
- Tetanus prophylaxis should be administered if the patient's immunization status is not up to date.
- Hand bites require special attention and often warrant consultation with a hand surgeon due to the risk of tendon, joint, or bone involvement.
- Wounds over joints or involving tendons should not be primarily closed, and patients should be advised to elevate the affected area and monitor for signs of infection such as increasing pain, redness, swelling, or purulent drainage.
- Human bites are particularly concerning because human saliva contains numerous pathogens, and the crushing mechanism of the bite can introduce these organisms deep into tissues, as noted in the guidelines for the diagnosis and management of skin and soft tissue infections 1.
- The decision to give “prophylactic” antibiotics should be based on wound severity and host immune competence, with a focus on high-risk wounds, such as those involving the face, hand, or foot, or in patients with immunocompromising disorders 1.
- Adjunctive therapeutic measures, such as wound cleansing and debridement, are also important in the management of human bites, as outlined in the practice guidelines for the diagnosis and management of skin and soft-tissue infections 1.
From the Research
Management of Human Bites
- Human bites are considered dangerous injuries with potentially serious complications, including infection, cellulitis, or osteomyelitis 2
- Management of human bites consists of:
- History and examination
- Wound care
- Surgical intervention if necessary
- Assessment of risk of disease transmission
- Appropriate antibiotic prophylaxis or treatment 2
- The best choice for oral or intravenous antibiotic therapy is the combination of a beta-lactam antibiotic with a beta-lactamase inhibitor 2
Treatment Outcomes
- Early treatment, appropriate prophylaxis, and surgical evaluation are key to achieving desired treatment outcomes 3
- Mixed aerobe and anaerobe infection is the most common type of infection, occurring in up to half of human bites 4
- Interventions to prevent complications of mammalian bites include antibiotic prophylaxis, antibiotics, debridement, decontamination, irrigation, primary wound closure, and tetanus vaccination 4
Wound Care and Prophylaxis
- Copious irrigation is an important aspect of wound care 5
- Early initiation of antimicrobial therapy, particularly in patients at high risk for infection, can decrease morbidity and mortality 5
- A patient's tetanus status and risk of rabies must be identified and appropriate immunoprophylaxis administered 5
- Clenched fist injuries often require surgical intervention and intravenous antibiotic therapy 2