What is the treatment for a monkey bite?

Treatment for a Monkey Bite

The treatment for a monkey bite requires immediate wound care, antibiotic therapy, and assessment for both rabies and herpes B virus prophylaxis, with the latter being particularly critical for macaque monkey bites due to the potentially fatal nature of herpes B virus infection.

Immediate Wound Management

• Thoroughly irrigate the wound with copious amounts of sterile normal saline for about 15 minutes 1
• Remove superficial debris but avoid deep debridement that could enlarge the wound 2
• Do not use iodine or antibiotic-containing solutions for cleaning 2, 1
• Do not close infected wounds; consider approximation with Steri-Strips or delayed closure 2, 1
• Facial wounds may be closed primarily if there has been meticulous wound care, copious irrigation, and prophylactic antibiotics 2

Antibiotic Therapy

• Administer amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days as first-line therapy 1
• For penicillin-allergic patients, alternatives include:
  • Doxycycline 100 mg twice daily
  • Fluoroquinolone plus metronidazole
  • Clindamycin plus TMP-SMZ 1

Rabies Prophylaxis

• Immediately report the monkey bite to local health officials to determine if rabies post-exposure prophylaxis (PEP) is indicated 1
• If indicated, administer:
  • Rabies immune globulin (RIG) at 20 IU/kg body weight, infiltrating as much as possible into and around the wound
  • First dose of rabies vaccine on day 0, followed by additional doses on days 3,7,14, and 28 1
• Wild mammals that bite humans should be considered for euthanasia and rabies examination 2

Herpes B Virus Prophylaxis (Critical for Macaque Monkey Bites)

• Administer acyclovir for prophylactic coverage against herpes B virus, which is endemic in macaque monkeys and can cause fatal encephalomyelitis in humans 3, 4
• Herpes B virus infection is highly prevalent (80-90%) in adult macaques 5
• This risk is particularly important as 67% of tested macaques in non-occupational exposure incidents were seropositive for herpes B virus 5

Tetanus Prophylaxis

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• Administer tetanus toxoid (0.5 mL intramuscularly) if status is outdated or unknown 2, 1

Follow-up and Monitoring

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

Special Considerations

• Children are more than three times as likely to be bitten by monkeys than adults 5
• Monkey bites frequently occur in travelers visiting tropical countries, particularly in South Asia at tourist sites 4, 6
• Macaque monkeys are unsuitable as pets due to the high risk of herpes B virus transmission 5

Remember that monkey bites require early aggressive intervention due to the risk of serious bacterial and viral infections 7. The combination of proper wound care, appropriate antibiotic therapy, and specific viral prophylaxis (rabies and herpes B) is essential for preventing potentially fatal complications.