What is the treatment for a squirrel bite?

Management of Squirrel Bite Wounds

Squirrel bite wounds should be treated with thorough wound irrigation using sterile normal saline or warm potable water, followed by prophylactic antibiotics (amoxicillin-clavulanate) for 3-5 days, and evaluation for tetanus and rabies prophylaxis. 1

Initial Wound Management

Immediate Care

• Thoroughly irrigate the wound with copious amounts of sterile normal saline or warm potable water for approximately 15 minutes 2, 1
• Avoid using iodine or antibiotic-containing solutions for irrigation 2, 1
• Remove superficial debris but avoid deep debridement that could enlarge the wound 2, 1
• Do not apply suction to the bite wound 2

Wound Closure Considerations

• Infected wounds should not be closed 2, 1
• For facial wounds, primary closure may be considered for cosmetic reasons if there has been meticulous wound care, copious irrigation, and prophylactic antibiotics 2, 1
• For other wounds, consider approximation with Steri-Strips and subsequent closure by either delayed primary or secondary intent 2, 1

Antibiotic Therapy

First-Line Treatment

• Amoxicillin-clavulanate (875/125 mg twice daily for adults) for 3-5 days is the recommended first-line treatment 1
• This provides coverage for both aerobic and anaerobic bacteria commonly found in animal bite wounds 1

Alternative Options (for penicillin-allergic patients)

• Doxycycline (100 mg twice daily) 1
• Fluoroquinolone plus metronidazole 1
• Clindamycin plus trimethoprim-sulfamethoxazole 1

Indications for Prophylactic Antibiotics

• Immunocompromised patients 1
• Asplenic patients 1
• Patients with advanced liver disease 1
• Wounds with resultant edema 1
• Moderate to severe injuries, especially to hand or face 1
• Injuries that may have penetrated periosteum or joint capsule 1

Antibiotics to Avoid

• First-generation cephalosporins 1
• Penicillinase-resistant penicillins 1
• Macrolides 1
• Clindamycin alone 1

Prophylaxis Considerations

Tetanus Prophylaxis

• Evaluate tetanus vaccination status 2, 1
• Administer tetanus toxoid (0.5 mL intramuscularly) if status is outdated or unknown 2, 1

Rabies Prophylaxis

• Consider rabies prophylaxis for all feral and wild animal bites 2
• Consult the local department of health about the risks and benefits of rabies prophylaxis 2, 1
• If indicated, administer rabies immunoglobulin on day 0, followed by rabies human diploid cell vaccination at a different site 2, 1

Follow-up Care

• Elevate the affected area if there is inflammation 1
• Follow up within 24 hours either by phone or during an office visit 2, 1
• Monitor for signs of infection including redness, swelling, warmth, and pain 1
• If infection progresses despite appropriate therapy, consider hospitalization 2

Special Considerations

Potential Complications

• Be vigilant for rare but serious infections such as tularemia, which has been reported after squirrel bites 3
• Watch for signs of necrotizing soft tissue infection, which though rare, has been reported following squirrel bites 4
• Other potential complications include osteomyelitis, synovitis, nerve or tendon injury, compartment syndromes, post-infectious arthritis, fracture, and bleeding 2

Hand Bites

• Hand bites require special attention as they have a higher risk of infection 1, 5
• Prophylactic antibiotics have been shown to significantly reduce infection rates in hand bites (NNT = 4) 5

By following this comprehensive approach to squirrel bite management, clinicians can effectively prevent infection and other complications while ensuring optimal wound healing.