From the Guidelines
The recommended antibiotic treatment for a human bite is amoxicillin-clavulanate, typically prescribed at a dose of 875/125 mg twice daily. This recommendation is based on the most recent and highest quality study available, which suggests that amoxicillin-clavulanate is effective against a wide range of bacteria that can cause infections in human bites, including streptococci, S. aureus, and Eikenella corrodens, as well as multiple anaerobic organisms 1.
Key Considerations
- Human bites have a high risk of infection due to the presence of numerous bacteria in the human mouth, including aerobic and anaerobic species.
- Proper wound care is essential, including thorough cleaning with soap and water, debridement of devitalized tissue if necessary, and consideration of tetanus prophylaxis if the patient's immunization status is not up to date.
- Alternative antibiotics, such as doxycycline 100 mg twice daily, trimethoprim-sulfamethoxazole (TMP-SMX) plus metronidazole, or a fluoroquinolone plus metronidazole, may be considered for patients with penicillin allergies or other contraindications to amoxicillin-clavulanate 1.
Special Cases
- Deep puncture wounds, bites to the hand or over joints, and bites in immunocompromised individuals may require more aggressive treatment and possibly surgical consultation.
- The bacteriology of human bite wounds can be complex, and empirical therapy may miss certain pathogens, highlighting the importance of prompt medical attention and consideration of culture results when available 1.
Treatment Duration
- The typical duration of antibiotic treatment for a human bite is 5-7 days, but this may vary depending on the severity of the infection and the patient's response to treatment 1.
From the Research
Antibiotic Treatment for Human Bites
- The recommended antibiotic treatment for human bite infections is phenoxymethyl penicillin in combination with penicillinase-stable penicillin 2.
- Human bites differ from animal bites in terms of the prevalence of certain pathogens, with a higher prevalence of Staphylococcus aureus and Eikenella corrodens 2.
- In cases where there is slow recovery or no improvement, simultaneous lymphadenopathy or pneumonia, S. aureus or Francisella tularensis should be suspected, and ciprofloxacin may be recommended 2.
- Amoxycillin/clavulanate (Augmentin) has been shown to be effective in the treatment of severe Staphylococcus aureus infections, including those caused by methicillin-sensitive isolates of S. aureus (MSSA) 3.
- However, the use of amoxycillin/clavulanate against methicillin-resistant strains of S. aureus (MRSA) is still experimental and not currently advocated for the treatment of MRSA infections in humans 3.
General Principles of Bite Wound Care
- Bite wounds require an organized, standardized approach to care to help prevent complications 4.
- This approach involves eliciting a history of the circumstances surrounding the bite and the patient's medical history, performing basic bite wound care, and considering rabies and tetanus prophylaxis 4.
- A good understanding of bite wound bacteriology and the situations in which antibiotics may be indicated is important for effective treatment 4.