Should human bites be treated with antibiotics?

From the Guidelines

Human bites should generally be treated with antibiotics due to the high risk of infection. For most human bite wounds, amoxicillin-clavulanate (Augmentin) is the preferred antibiotic, typically prescribed at 875/125 mg twice daily for 3-5 days for minor bites or 5-7 days for more severe injuries 1. The oral cavity contains numerous bacteria, including aerobic and anaerobic species like Streptococcus, Staphylococcus, and Eikenella, which can cause serious infections when introduced into wounds.

Key Considerations

• Treatment should begin as soon as possible after the injury occurs.
• In addition to antibiotics, proper wound care is essential - thoroughly clean the wound with soap and water, apply antiseptic, and seek medical attention promptly, especially for bites on the hands, face, or joints, or if the wound is deep or gaping.
• People with compromised immune systems, diabetes, or liver disease should be particularly vigilant about seeking treatment for human bites as they face higher risks of complications 1.
• The decision to give “prophylactic” antibiotics should be based on wound severity and host immune competence 1.

Antibiotic Choices

• Amoxicillin-clavulanate is recommended for its broad coverage of aerobic and anaerobic bacteria.
• Alternative options may include ampicillin-sulbactam, or ertapenem for patients with a history of hypersensitivity to β-lactams.
• Fluoroquinolones, such as ciprofloxacin or levofloxacin, plus metronidazole, or moxifloxacin as a single agent, may also be considered 1.

From the Research

Human Bites and Antibiotic Treatment

• Human bites can be complex injuries due to the polymicrobial nature of human saliva, which poses a risk for transmission of infectious diseases 2.
• The bacteriology of infected human bites includes a spectrum of bacteria, with Eikenella corrodens being a common complication 3, 4.
• Antibiotic therapy is indicated for infected human bites, as well as for fresh wounds considered at risk for infection 3, 4.
• Amoxicillin-clavulanate and moxifloxacin are recommended for their broad-spectrum coverage of the pathogenic flora 3.
• The use of prophylactic antibiotics in human bites has been shown to reduce the rate of infection, particularly in hand bites 5.

Specific Considerations

• Human bites of the face, lips, and ears are at low risk for infection if properly treated 4.
• Closed-fist injuries (CFI) have a higher risk of infection and should be identified early and aggressively irrigated and debrided 4.
• The choice of antibiotic should be based on the specific bacteriology of the wound and the patient's individual risk factors 3, 4.
• Prophylactic antibiotics are not indicated for typical bite wounds that are low risk 4.

Treatment Recommendations

• Early treatment, appropriate prophylaxis, and surgical evaluation are key to achieving desired treatment outcomes for human bites 2.
• Antibiotic therapy should be tailored to the specific needs of the patient and the wound 3, 4.
• Wound management, including irrigation and debridement, is crucial for preventing infection 3.