What is the emergency treatment for a monkey bite?

Emergency Treatment for Monkey Bites

The emergency treatment for a monkey bite requires immediate and thorough wound irrigation with copious amounts of water or saline, followed by rabies post-exposure prophylaxis and consideration of antiviral therapy for herpes B virus, especially for macaque monkey bites. 1, 2

Immediate Wound Management

1. Wound Cleansing:

   • Immediately wash and flush the bite wound with soap and water for at least 15 minutes 2
   • Thoroughly irrigate with a large volume of warm or room temperature potable water to remove any foreign matter 1, 2
   • Remove any superficial debris but avoid deeper debridement unless absolutely necessary 2

2. Wound Assessment:

   • Evaluate the depth and location of the wound
   • Pay special attention to bites on the hands, face, or over joints which have higher risk of complications 2
   • Document the species of monkey if known (especially important to identify if it was a macaque) 3, 4

Infection Prevention

Bacterial Infection Prevention

• Antibiotic Prophylaxis:
  • Administer amoxicillin-clavulanate (875/125 mg twice daily for 3-5 days) 2
  • For penicillin-allergic patients, use doxycycline, fluoroquinolone plus metronidazole, or clindamycin plus TMP-SMZ 2
  • Monkey bites are at high risk for bacterial infections including Pasteurella, Staphylococcus, Streptococcus species 1

Viral Infection Prevention

1. Rabies Post-Exposure Prophylaxis (PEP):

   • Administer 20 IU/kg body weight of Rabies Immune Globulin (RIG), infiltrating around the wound 2
   • For previously unvaccinated individuals, administer 5 doses of rabies vaccine on days 0,3,7,14, and 28 2
   • PEP should be initiated as soon as possible, regardless of delay since exposure 1

2. Herpes B Virus Prophylaxis:

   • For macaque monkey bites (especially important), administer acyclovir prophylaxis 3, 4
   • Herpes B virus is endemic in macaque monkeys and can cause fatal encephalomyelitis in humans 3, 4, 5
   • This is particularly critical as herpes B infection in humans is usually fatal 4

Tetanus Prophylaxis

• Administer tetanus toxoid if vaccination is outdated (>5 years) or status is unknown 2
• Tetanus, diphtheria, and pertussis (Tdap) is preferred over Tetanus and diphtheria (Td) if the former has not been previously given 2

Wound Closure Considerations

• Facial wounds may be closed primarily after thorough cleaning and with prophylactic antibiotics 2
• For non-facial wounds, consider leaving open or using Steri-Strips rather than suturing, especially if >8 hours old 2
• Do not close infected wounds 2

Follow-up and Monitoring

• 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 there is inflammation to accelerate healing 2

Special Considerations

• Hand bites, particularly over joints or tendons, may require consultation with a hand specialist 2
• Consider hospitalization if infection progresses despite appropriate therapy 2
• Monkey bites are becoming increasingly common among travelers to countries like India, Thailand, Indonesia, and Bali 6, 7, 5

Common Pitfalls to Avoid

• Failing to identify macaque species: Macaque monkeys specifically carry herpes B virus which can be fatal to humans 3, 4
• Delayed treatment: Monkey bites require early aggressive intervention 4
• Inadequate wound irrigation: Thorough cleaning is critical to prevent infection 1, 2
• Overlooking herpes B virus risk: While rare in travelers, the potentially fatal outcome warrants prophylactic treatment, especially with macaque bites 3, 5