What is the treatment for a child bitten by another child?

Treatment for a Child Bitten by Another Child

The treatment for a child bitten by another child should include thorough wound cleansing, consideration of antibiotic prophylaxis with amoxicillin-clavulanate, and appropriate follow-up within 24-48 hours to monitor for infection. 1, 2

Initial Wound Management

1. Wound Cleansing:

   • Thoroughly clean the wound with sterile normal saline and perform copious irrigation to prevent infection 2
   • For fresh wounds, consider povidone-iodine solution as a virucidal agent 2
   • Remove any superficial debris but avoid deeper debridement unless absolutely necessary 2

2. Wound Closure:

   • Fresh wounds (<8 hours old) may be approximated with Steri-Strips rather than sutures
   • Exception: Facial wounds can be closed primarily 2
   • Do not close infected wounds 2

3. Wound Care:

   • Elevate the injured area, especially if swollen, to accelerate healing 2
   • Consider passive immobilization methods as needed 2

Antibiotic Therapy

For human bites, antibiotic prophylaxis is strongly recommended due to high risk of infection:

1. First-line therapy (oral):

   • Amoxicillin-clavulanate 875/125 mg twice daily (adult dose) or appropriate pediatric dosing for 3-5 days 1, 2
   • Particularly important for bites to the hand or face, deep puncture wounds, immunocompromised patients, and wounds with significant tissue damage

2. For penicillin-allergic patients:

   • Doxycycline 100 mg twice daily (not recommended for young children)
   • Fluoroquinolone plus metronidazole
   • Clindamycin plus TMP-SMZ 1, 2

3. For severe infections requiring IV therapy:

   • Ampicillin-sulbactam 1.5-3.0 g every 6 hours (adult dose)
   • Piperacillin-tazobactam 3.37 g every 6-8 hours (adult dose) 1

Tetanus Prophylaxis

• Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination is outdated (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

Special Considerations

1. High-risk bite locations:

   • Hand bites, particularly over joints or tendons, are at higher risk of infection and complications
   • Consider consultation with a hand specialist if joint spaces or tendons are involved 2

2. Microbiology of human bites:

   • Human bite wounds typically contain multiple bacterial species including oral flora
   • Cultures of infected bite wounds yield an average of five microorganisms 3, 4
   • Common pathogens include Staphylococcus aureus, Streptococcus species, and anaerobes 4

3. Monitoring for complications:

   • Infection is the most common complication 3
   • Potential complications include osteomyelitis, synovitis, nerve or tendon injury, compartment syndromes, post-infectious arthritis, fracture, and bleeding 2

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
• Consider hospitalization if infection progresses despite appropriate therapy 2
• Pain disproportionate to injury near a bone or joint may suggest periosteal penetration 2

Important Caveats

• First-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone have poor activity against some organisms commonly found in human bites and should be avoided as monotherapy 2
• Infected wounds should never be closed 2
• Hand bites require particularly careful evaluation and management due to higher risk of complications 2, 4
• For children with suspected toxin-producing infections (indicated by rapid progression, systemic symptoms), consider adding clindamycin to the antibiotic regimen 5