What is the treatment for a fox bite?

Treatment for Fox Bite

Fox bites require immediate wound cleansing followed by rabies post-exposure prophylaxis (PEP) including both rabies immune globulin and vaccine series, as foxes are considered high-risk rabies vector species. 1

Immediate Wound Management

1. Thorough wound cleansing:

   • Immediately wash and flush all bite wounds with soap and water for at least 15 minutes 1, 2
   • Apply an iodine-containing or other virucidal topical preparation to the wound 3
   • Remove any superficial debris but avoid deep debridement unless necessary 2

2. Wound closure considerations:

   • Facial wounds may be closed primarily after thorough cleaning
   • For other wounds, consider using Steri-Strips or leaving open
   • Avoid suturing wounds >8 hours old (except facial wounds) 2
   • Do not close infected wounds 2

Rabies Post-Exposure Prophylaxis

Foxes are considered high-risk rabies vector species, and bites should be treated as potential rabies exposures 1.

1. Rabies Immune Globulin (RIG):

   • Administer 20 IU/kg body weight 1
   • Infiltrate the full dose around and into the wound if anatomically feasible
   • Inject any remaining volume intramuscularly at a site distant from vaccine administration 1, 3

2. Rabies Vaccine:

   • For previously unvaccinated individuals: 5 doses of rabies vaccine on days 0,3,7,14, and 28 1
   • For previously vaccinated individuals: 2 doses of vaccine on days 0 and 3 (no RIG needed) 3

Antibiotic Prophylaxis

• Administer amoxicillin-clavulanate (875/125 mg twice daily for 3-5 days) 2
• For penicillin-allergic patients: doxycycline (100 mg twice daily), fluoroquinolone plus metronidazole, or clindamycin plus TMP-SMZ 2
• Children under 8 years should not receive doxycycline 2

Tetanus Prophylaxis

• Evaluate tetanus vaccination status
• Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination is outdated (>5 years) or status unknown 2

Special Considerations

1. High-risk bite locations:

   • Bites to the hand, face, or over joints/tendons require special attention 2
   • Face and neck bites may allow more rapid viral entry to the central nervous system 4, 5

2. Timing of treatment:

   • PEP should be initiated as soon as possible after exposure
   • However, PEP is indicated regardless of the delay between exposure and treatment, provided clinical signs of rabies are not present 1

3. Animal handling:

   • If the fox is available, it should be euthanized and tested for rabies 1, 3
   • If testing is negative, PEP can be discontinued 3

Follow-up Care

• Schedule follow-up within 24-48 hours to assess for signs of infection 2
• Monitor for increasing redness, swelling, pain, warmth, or drainage 2
• Elevate the affected area if inflammation is present 2

Pitfalls and Caveats

1. Never delay rabies PEP while waiting for animal testing results - initiate treatment immediately for fox bites 1, 3
2. Inadequate wound cleansing increases risk of both rabies and bacterial infection 1, 2
3. Insufficient RIG infiltration around the wound has been associated with PEP failures 1
4. Deviations from recommended PEP protocol have been associated with vaccination failure and human mortality 6
5. Face and neck bites carry higher risk due to proximity to the central nervous system and require urgent attention 4, 5

Case reports demonstrate that inadequate or delayed PEP following fox bites has resulted in human rabies deaths 4, 7, while proper administration of PEP has been shown to be highly effective in preventing rabies even after exposure to confirmed rabid foxes 6, 4.