What is the treatment for animal bite illnesses?

Treatment for Animal Bite Illnesses

The essential components of animal bite treatment include immediate and thorough wound cleansing with soap and water for at least 15 minutes, appropriate antibiotic prophylaxis, rabies post-exposure prophylaxis when indicated, and tetanus prophylaxis as needed. 1

Immediate Wound Management

• Thorough wound cleansing:

  • Immediately wash and flush all bite wounds with soap and water for at least 15 minutes 1
  • Use povidone-iodine solution for irrigation as a virucidal agent 2, 1
  • Remove any superficial debris but avoid deeper debridement unless necessary 1

• Wound closure considerations:

  • Facial wounds may be closed primarily after thorough cleaning with prophylactic antibiotics 1
  • Non-facial wounds should be considered for closure with Steri-Strips or left open 1
  • Avoid suturing wounds >8 hours old (except facial wounds) 1
  • Do not close infected wounds 1

Antibiotic Prophylaxis

• Indications for antibiotic prophylaxis:

  • Bites to the hand or face
  • Deep puncture wounds
  • Immunocompromised patients
  • Wounds with significant tissue damage 1

• First-line antibiotic regimen:

  • Amoxicillin-clavulanate (875/125 mg twice daily for 3-5 days) 1

• Alternative regimens for penicillin-allergic patients:

  • Doxycycline (100 mg twice daily)
  • Fluoroquinolone plus metronidazole
  • Clindamycin plus TMP-SMZ 1

Rabies Post-Exposure Prophylaxis (PEP)

• Indications for rabies PEP:

  • Bites from wild skunks, raccoons, foxes, and most carnivores should be regarded as rabid unless proven negative by laboratory tests 3
  • For domestic dogs, cats, and ferrets, base decision on animal's health status and observation period 3
  • Unprovoked attacks are more likely to indicate rabies than provoked attacks 2

• PEP protocol for previously unvaccinated persons:

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

• PEP for previously vaccinated individuals:

  • Administer vaccine alone without RIG 2, 3

Tetanus Prophylaxis

• Administer tetanus toxoid if vaccination is outdated (>5 years) or status is unknown 1
• Tetanus, diphtheria, and pertussis (Tdap) is preferred over Tetanus and diphtheria (Td) if the former has not been previously given 1

Animal-Specific Considerations

Dogs and Cats

• Healthy domestic dogs and cats that bite a person may be confined and observed for 10 days 2
• Any illness in the animal during confinement should be evaluated by a veterinarian and reported to public health authorities 2
• If signs of rabies develop, the animal should be euthanized and tested 2, 3

Wild Animals

• Post-exposure prophylaxis should be initiated immediately following exposure to wildlife unless the animal is available for testing 3
• Small rodents (squirrels, chipmunks, rats, mice) and lagomorphs (rabbits, hares) rarely transmit rabies to humans 3

Follow-up and Monitoring

• Schedule follow-up within 24-48 hours to assess for signs of infection 1
• Monitor for increasing redness, swelling, pain, warmth, or drainage 1
• Elevate the affected area if there is inflammation 1
• Consider hospitalization if infection progresses despite appropriate therapy 1

Special Considerations for Hand Bites

• Hand bites are at higher risk for infection and complications 1
• Prophylactic antibiotics significantly reduce infection rates in hand bites (NNT = 4) 1, 4
• Consider consultation with a hand specialist if joint spaces or tendons are involved 1

Common Pitfalls to Avoid

1. Delaying wound cleansing, which is critical for preventing rabies and bacterial infections 2, 1
2. Failing to consider rabies prophylaxis for wild animal bites 3
3. Overlooking tetanus prophylaxis 1
4. Inappropriate wound closure, especially for puncture wounds or infected wounds 1
5. Not recognizing the higher infection risk of cat bites and human bites compared to dog bites 5

By following these evidence-based guidelines, clinicians can effectively manage animal bite illnesses and prevent serious complications including infection, rabies, and tetanus.