What is the treatment for a human bite?

Treatment of Human Bites

Human bite wounds should be treated with copious irrigation using water or saline, followed by prophylactic antibiotics, specifically amoxicillin-clavulanic acid, with consideration for wound closure based on location and time since injury. 1

Initial Wound Management

• Immediate and thorough irrigation of the bite wound with copious amounts of water or saline is essential to minimize the risk of bacterial infection 1
• No specific irrigation fluid has proven superior to others, but the mechanical action of irrigation is critical for removing bacteria 1
• After irrigation, assess the wound for depth, location, and involvement of underlying structures 2

Antibiotic Therapy

• Prophylactic antibiotics should be administered early regardless of wound appearance due to the high risk of infection from human bites 3
• Amoxicillin-clavulanic acid is the first-line antibiotic treatment for human bites as it covers the typical polymicrobial flora including Eikenella corrodens 1, 4
• For patients with penicillin allergies, alternative options include carbapenems and doxycycline 1
• For severe infections or in cases requiring intravenous therapy, options include ampicillin-sulbactam, piperacillin-tazobactam, or carbapenems 1

Wound Closure Considerations

• Primary wound closure should be avoided when possible to reduce infection risk, especially for hand injuries 1, 5
• Facial bites may be considered for primary closure due to cosmetic concerns, but only if they are clinically uninfected and presented early 5
• Infected wounds should never be closed 3
• Clenched-fist injuries (fight bites) require special attention as they often involve joint spaces and tendons, typically requiring surgical intervention and intravenous antibiotics 4

Special Considerations Based on Location

• Hand bites carry the highest risk of complications and should be treated more aggressively with early antibiotic therapy and potential surgical consultation 6
• Categorize human bites to the hand into three types for management: occlusional/simple, clenched fist injuries, and occlusional bites to the hand 6
• Facial bites generally have better blood supply and lower infection rates, making them more amenable to primary closure after thorough cleaning 5

Tetanus Prophylaxis

• Administer tetanus prophylaxis based on the patient's immunization status 3
• If tetanus vaccination status is outdated or unknown, administer tetanus toxoid (0.5 mL intramuscularly) 3

Monitoring and Follow-up

• All human bite wounds should be reassessed within 24-48 hours for signs of infection 2
• Signs of infection include increasing pain, erythema, swelling, purulent discharge, lymphangitis, or systemic symptoms 4
• Infected wounds may require more aggressive treatment including surgical debridement and intravenous antibiotics 4

Common Pitfalls to Avoid

• Failing to recognize clenched-fist injuries (closed-fist injuries against teeth), which have high complication rates and often require surgical intervention 4
• Underestimating the infection risk of human bites, which can lead to delayed treatment and complications 2
• Premature closure of potentially contaminated wounds, especially those on the hands 5
• Inadequate irrigation and debridement, which are as important as antibiotic therapy in preventing infection 1, 5

Human bites should be taken seriously due to their polymicrobial nature and risk of severe infection. Early and aggressive treatment with proper wound care and appropriate antibiotics is essential for optimal outcomes 2.