What is the recommended treatment for a human bite?

Treatment of Human Bite Wounds

The recommended treatment for human bite wounds includes thorough irrigation with copious amounts of water or saline, appropriate antibiotic prophylaxis for all cases regardless of wound appearance, and proper wound management including consideration of tetanus prophylaxis. 1

Initial Wound Management

Immediate Wound Care

• Perform immediate and thorough cleansing of all bite wounds with:
  • Copious irrigation using water or saline 1
  • Gentle removal of superficial debris 1
  • Avoid deeper debridement unless absolutely necessary to prevent enlarging the wound 1

Wound Assessment

• Evaluate for:
  • Penetration into synovium, joint capsule, or bone (especially for clenched-fist injuries) 1
  • Nerve or tendon damage 1
  • Embedded teeth fragments, particularly in children's injuries 1

Antimicrobial Therapy

Antibiotic Prophylaxis

• All human bite wounds require prophylactic antibiotics regardless of wound appearance 1
• This differs from animal bites, where antibiotics may be withheld for minor wounds
• Recommended antibiotics:
  • First-line: Combination of beta-lactam antibiotic with beta-lactamase inhibitor (e.g., amoxicillin-clavulanate) 2
  • Target organisms include:
    • Streptococci (present in 80% of wounds)
    • Staphylococci
    • Haemophilus species
    • Eikenella corrodens
    • Anaerobes (Fusobacterium, peptostreptococci, Prevotella, Porphyromonas) 1

Duration of Therapy

• Uncomplicated wounds: 5-7 days
• Septic arthritis: 4 weeks
• Osteomyelitis: 6 weeks 1

Wound Closure Considerations

• Infected wounds should not be closed 1
• Early wound closure (<8 hours) is controversial:
  • Facial wounds may be closed primarily if there has been meticulous wound care, copious irrigation, and administration of prophylactic antibiotics 1
  • For other locations, consider approximation with Steri-Strips and delayed primary or secondary closure 1

Additional Prophylaxis

Tetanus Prophylaxis

• Ensure tetanus prophylaxis is current
• If outdated or unknown status, administer tetanus toxoid (0.5 mL intramuscularly) 1

Blood-Borne Pathogen Consideration

• Human bites can potentially transmit:
  • Hepatitis B and C
  • HIV
  • Herpes 1, 3
• Follow institutional "needle stick protocols" for risk stratification 4

Special Considerations

Clenched-Fist Injuries

• Require special attention due to high risk of complications 2
• Should be evaluated by a hand specialist 1
• Often require surgical intervention and intravenous antibiotic therapy 2
• Elevate the injured extremity using a passive method (sling for outpatients, tubular stockinet and IV pole for inpatients) 1

Follow-up Care

• Outpatients should be followed up within 24 hours either by phone or during an office visit
• If infection progresses despite appropriate therapy, consider hospitalization 1

Common Pitfalls to Avoid

1. Failing to recognize human bites as potentially serious injuries with high infection rates
2. Inadequate irrigation of the wound
3. Premature closure of contaminated wounds
4. Overlooking the need for prophylactic antibiotics in all human bite cases
5. Missing deep structure involvement, especially in clenched-fist injuries
6. Neglecting tetanus prophylaxis and blood-borne pathogen risk assessment

Human bite wounds require prompt, thorough treatment due to their polymicrobial nature and high risk of complications. Proper wound cleansing, appropriate antibiotic therapy, and careful consideration of wound closure timing are essential to prevent serious infections and ensure optimal outcomes.